Homestead_Tinsley e' ' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
7>l ! FORM
STANDARD!SUPPLEMENTAL DEDUCTION �L-
'y • State Form 5473(R19 11-23)
HC10
Prescribed by the Department of Local Government Finance 1
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under/C 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) 3- t ,rs_s certify that I(we)occupied as my(our)principal place of
residence or am(ar}, tying the(o o I s i d real,3�o arty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application signed, t I irk
- G {Gate of signature).I(We):
L1QOwn. ❑ (are)buying under recorded contrail.
❑ (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.
0 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 c__) Township 0 0 ` Taxing District(city, own,bwnshi *_ f '
CA
Parcel Number Legal Description I th roperiy in question: `r\1.-j
CI 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 surrou s at structure is used to produce income,describe the use and portion
of the property utilized to produce income. //^�� p/'�.(^^�� p^'''`�
/`'j�)�(/J(/ter] I S--2-1 --3 ,/ 0--� °tf �/ . GSS - c`/
tA
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
❑Yes ❑No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete. t
i
A.dress_of C intact(numrat+d stare ,gatg,and ZIP code) .-1") A.dress of Vacated Homestead,if a.,.a umber and street,city,state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Reside One Acre Immediately (1)
Surrounding Residential Improvement
Other Land • (2) E.
,i)Total Land(line 1 plus line 2) (3) JJ��///�}}
Residential improvements or Dwelling (4) NO 2(90 Annually Assessed Mobile/
Manufactured Home Garage (5) G 24
Other Improvements (6) G/eP�L`rGt •
Total Improvements(Line 4 through Line 6) (7) Ohl Clio .f/
A171'4137..
Total Value(Line 3 plus Line 7) (8) 'r.0q
Signature of Assessor Date Signed(date,month.year)
I hereby certify the above is true,correct,and complete.
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$48,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $
1s not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed one-half(112)of the assessed value of the mobile home or u a ome.
Signature of AudilohY��, /���.�7 A/3—� Date Signed( of ,y r)7,,_./ �r z w —
DISTRIBUTION: Oriigiinal-CountyAuuditor,File-Stttaam`pel`d,/Co`py-Tax yer 1 IL /r�'� `✓4
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