Homestead_Hulfachor a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
'1. STANDARD I SUPPLEMENTAL DEDUCTION FORM20 t
State Form 5473(R19/1 23) HC10 t4
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) * e • l r& • certify that I(we)occupied as my(our)principal place of
residence or arr(are)b •r' the f Ilowi r•.: Bribed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
dat this application is signed, (date of signature).I(We):
Own. Am(are)buying under recorded contract.
(are)entitled to occupy as a ten t- ckholder of a cooperative housing corporation.
❑Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
If Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County l Township Ci Taxing District(cntown,fo ip)
J\ C) •
Parcel Number - Legal Description Is the roperty in question:
• Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately su n that structure is used to produce income,describe the use and portion
of the property utilized to produce income. } (n
—C - \ Lk 8"--.
v PROPERTY OWNED ELSEWHERE BY CLAIMANT �/
State,County,and Township Is Claimant Vecati omestead7
❑Yes Ir.No
Signal .e of Claimant y
I hereby certify the above statements are true,correct,and complete.
i
Address of Contact(number and street,city,state,and ZIP cod Address o •ace ed H..-.es .•,i any(number and streetity,stale,an de)
2 0 lO -_ _ S 0 u.cli li-31\-L- -b D
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement .
Other Land (2) .
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5)
. ..6 a
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8) w
Signature of Assessor ®^ (OSigned(date,month.year)
. I hereby certify the above Is true,correct,and complete. �s G yG
Verifying Action-Signature of Auditor / "OA _ / Date Signed(date,month,year)
OVN `�'�1�1
STANDARD DEDUCTION ALLOWANCE
w•
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $
is not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile ho//.--. .anufactured home. I`7/
Signature of Auditor n �l� EP Date Sign@d�m fh,da at1 ar) t 1 •r-'-fit, ��)r"(,'+ti� r
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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