Homestead_Hornby , CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
- t:. } STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R19/1-23) HC10 �Z� -
�" Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. l
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. v\V o. certify that I(we)occupied as my(our)principal place of
residence or a (are)buying We folioµ�ing descri fe�I'property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
Xis application is signed, 1 I If`L'I•" 'I. (date of signature).I(We):
n. L"!Am(are)buying under recorded contract.(are)entitled to occupy as a tenant-stockholder 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.
❑
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township rw('�),{l��'}�,v� Taxing District fr�11sn,townshi
Parcel Num•e So Legal Description s i - ,rope fry i lido:1 c
I:/Real Property ❑Annualy 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 sun, n,s that structure is used to produce income,describe the use and portion
of the properly utilized to reduce income.
13 _ 10 . 200 -000 50 (A _ 006
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Slate,County,and Township Is Claimant Vacati omestead7
❑Yes �:1 No _ n r
I 'nature of Glaiman /i y�jl�//y
I hereby certify the above statements are true,correct,and complete. AIL ......4( 1.• . k.11'.1 . t_.4,-- -4,li
J
CR\ Address I Contact(rum er an I, ity,state an fP ode) 'dress of Vacal.f. omestead,if any(number and street illy,state,an•ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE I 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) 11
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) ra/
4/0k ` .
eee
Other Improvements (6) [Jel 6 •
Total Improvements(Line 4 through Line 6) (7) 0/ o?Q
Total Value(Line 3 plus Line 7) (8) �h L'O&Y
Signature of Assessor NTY ate Signed(date,month,year)
I hereby certify the above is true,correct,and complete. Al
Verifying Action—Signature of Auditor &GSign ed(date,month,year)
STANDARD DEDUCTION ALLOWANCE ''TT
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 Io 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 ma,"_ •:-or manufactured home.
Signature of Audit Dal er.e ( onrh da Veer)
DISTRIBUTION: Original—County Auditor,File-Stamped Copy—Taxpayer • \
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