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Homestead_Cartwright r` = CLAIM FOR HOMESTEAD PROPERTY TAX YEAR s, STANDARD I SUPPLEMENTAL DEDUCTION FORM •Mtit,• State Form 5473(R1911-23) HCid �i '!' Prescribed by the Department of Local Govemment Finance 111 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 t, i(We) QV t certify that I(we)occupied as my(our)principal place of residence or am(are)buying the f I w bed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the at is application is signed, Z (date of signature).I(We): • / LOwn. El are)buying under recorded contract. 0 A (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. D Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal re -nce tru . ❑Am(are)the shareholder,partner,or member of the entity that owns the property. Social Security Number of Claimant's Spouse(last five digits) Driver's License I Identification/Other Number of Claimant's Spouse past five digits) issuing State (Applicable only if applicant's spouse does not have a social security number) • CONTRACT RECORDED If Buying on Contract,Fee Simple Owner's Name Recorder's Office Where Contract is Recorded 'Record Number Page PROPERTY DESCRIPTION County 30 Township Taxing District(city,town, wpsh ti Parcel Numbe Legal Description ''8I lh roperty in qu1estion; Real Property ❑Annually Assessed Mobile Home(IC 6-1,1.7) If any puritan of the residential structure or the land not exceeding one(1)acre that immediately surra s that structure is used to produce income,describe the use and portion of the property utilized to/pprr000_d`uce income.\ ck......2 �1 to 000 .... 3----i_kl ....._. c-_-)2.5? . PROPERTY OWNED ELSEWHERE BY CLAIMANT ""� State,County,and Township Is C i ant Vacating a Homestead? ( \I • /Signature of Claimant AYes ,lu v I hereby certify the above statements are true,correct,and complete. �( C1G • / Address of Contact(number and str city,state,and ZIP code Address of Vacated Homestead,if any nu ar nd street,city,state,and 211c64.0 Lk ♦ WQ S)- fr, - in..._‘4 h . 1 2....5 2-sD `~� t ',-,- ln ((1 IPt. ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE • Land Not Exceeding One(1)Acre Immediately (1) J Surrounding Residential Improvement % �y 4 Other Land (2) Total Land(line 1 plus line 2) (3) Residential improvements or Dwelling (4) Annually Assessed Mobile f r �0.. ` Manufactured Home Garage (5) t� • Other improvements (6) C/©'O4, t eaz Total Improvements(Line 4 through Line 6) (7) r!/4 Total Value(Line 3 plus Line 7) (8) 4. Signature of Assessor �nTD Q./ Date Signed(date,month,year) I hereby certify the above is true,correct,and complete. rQ Verifying Action—Signature of Auditor Date Signed(date,month,year) STANDARD DEDUCTION ALLOWANCE 20 Pay 20 Lesser of 60%of the assessed value of the homestead or S48,000. 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 oftt(\home or manufactured home. {j,,( Signatur 'tc1r (^ , ! }^vl \ Date Sgid th,&"3a, 2,Li 11l t\ 1 l tf`lif C.. DISTRIBUTION:Original—County Auditor,File-Scam —Taxpayer Page 1 of 2