Homestead_Bryant (7) d�"'� �y� CLAIM FOR HOMESTEAD PROPERTY TAX
YEAR
STANDARD t SUPPLEMENTAL DEDUCTION FORM �a�
State Form 5473(R19 t 1-23) HC10
J 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 1C 6-1.1-12-37.
.�'}� N�^—. CERTIFICATION STATEMENT
t(We) I 'r` . `�!A' f certify that 1(we)occupied as my(our)principal place of
residence or am(are)bu tng the foil r s •ed r I roperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, / •` A (date of signature).t(We):
'Own. ❑Am(are)buying under recorded contract.
❑Am(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.
tf Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Countyi"t ie so Township O � q Taxing.�ict(city, wn,township) f 2
Parcel Number✓l/m Legal Description O�/`/ 'f�lIIss the properly y in question:
quuueessvtionn
Real Property ❑AnnualtyAssessed Mobile Home(IC 6-1.1-7)
If any porti of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the pro rty utilized to produce income.
' R6 -/A -01-1%`0(71 -- oi,c. 02/75-. 6 :c3. .
PROPERTY OWNED ELSEWHERE BY CLAIMANT'
State,County,"nd Tow f ' Fq�.1,.f.,�} / Is Claimant Vacating a Homestead?
4 <' •P,lt r OKA ❑yes tlo
Sir ature laimant
I hereby certify the above statements are true,correct,and completed
Addrepsf GC(�Jar)j�t(num er d scree,c' state,and ZIP co �l. 'Address of Va ed stead,if any umber and street,city,slate,and ZIP code)
L/ ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) . . v i
-Ow.
. 4 .
Total Land(line 1 plus line 2) (3) .a
Residential Improvements or Dwelling (4)
Annually Assessed Mobile t — DEC
Manufactured Home Garage (5) 1
Other Improvements (6) ®� ����
Total Improvements(Line 4 through Line 6) (7) t^/Qgf
Total Value(Line 3 plus Line 7) (8) C UNTY AI1�
Signature of Assessor Date Signed(date,month,year) TOR
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 $ (,)
/s not assessed as real property or to a manufactured home that is not assessed as real property may not (\„++VV'��11
exceed ne-ltmtf(1/2)of the assessed a e of them i home or manufacture home.
�� a s,
Signet Audi r .(/� /�/) Date j(/,>gj it,year v
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
I4+�'�+ 1,00
/�1J(�G r+rfj
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