Homestead_Hull (4) a% '.-t& CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
y ' FORM
,> 1:: STANDARD/SUPPLEMENTAL DEDUCTION
} State Form 5473(R19 I 1-23) HC10
ME•r' � 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
A III I(We) /, certify that I(we)occupied as my(our)principal place of
residence or.m(are)buying the foil wjpg dr ber11 property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date is application's signed, 11 `Q - �1•` (date of signature).I(We):
Own. Dam(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.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
- CONTRACT RECORDED
If Buying an Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County ^ Township ,•(') rh _ Taxing District(city,t wn,township)
Parcel Number y / Legal Description Ili/) (//`�/, Is 1 property In question:
Real Property ❑Annually Assessed f lcdle Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surf n s that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
....,..,(3 ..- ou,-2... -L.300 , 000 , 30.3 _ 02,0,
PROPERTY OWNED ELSEWHERE BY CLAIMANT (((
State,County,and Township Is C Im nt Vacating a Homestead? t,.J
[ Yes El No y!-_
t Signature of Claimant /\ _
I hereby certify IhQvsslatements are true,correct,and complete. N.
Address of Contact(number and street,city,state,. d Z c..e) Address of Vacated Homestead,if a (number an.sire=l,ci slate,and ZIP code i�
`� .... S �c 1. — 21 N Can =ty) • ' - Y1 9-6‘6. c)
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre ImmediatelyMr 0
Surrounding Residential Improvement (1) . - W
Other Land (2)
Total Land(line 1 plus line 2) (3) - ' } S
Residential Improvements or Dwelling (4) O
Annually Assessed Mobile I I
� r ry
Manufactured Home Garage (6) 1�+
Other Improvements (6) V 70
N `�
Total Improvements(Line 4 through Line 6) (7)
O
Total Value(Line 3 plus Line 7) (8) }f('Jr 0
Signature of Assessor A. ffA
IA.year)
I hereby certify the above is true,correct,and complete. 04(���((( �
*
Verifying Action-Sign alb re of Auditor G`BSUN Ci Dale Signed(dale,month,year)
STANDARD DEDUCTION ALLOWANCE
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 home•- •:ctured home.
Signature of At 0 ni 3C4...1 Date Signe (redo It,da ye ^ ^
wf ►11
DISTRIBUTION:Original-County Auditor,RleStamped Copy-Taxp. -
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