Homestead_Fox (3) ' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a STANDARD I SUPPLEMENTAL DEDUCTION FORM
•.' State Form 5473(R19/1-23)
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/C 6-1.1-12-37.
CERTIFICATION STATEMENT
S I(We) V. Itl certify that 1(we)occupied as my(our)principal place of
{ l_`T'�4 residence or am(are)buying th f In lie dt acJ„( p o erty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date is application is signed, •(� (•(J (date of signature).I(We):
Own. ❑ m(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.
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION .
County (won Township v Taxing District(city,town,Township
( Z - Ilie\
Parcel Number Legal Description s th property in question: `
", Real Property 0 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 sum n that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
'2.0 ..----11--—'''... ri, ,„....— l 0 11 ..--0 0 0. 3,:i 6 ...._ b2,,i;?,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati omestead?
❑Yes No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete,
Address c C,�ro`nt)1aet(number and street,city,statte,Xaand ZIPindal (� Address of of Va Homestead,if any(num er and street.city,state,and ZIP code)
ASSESSOR USE ONLY I 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 I plus line 2) (3)
Residential Improvements or Dwelling (4) ,.e4
Annually Assessed Mobile I Il ,
Manufactured Home Garage (5) Dec ;Iy 9 :,'S
Other Improvements (6) I"" G0j
U,247
c
Total Improvements(Line 4 through Line 6) (7) J�`SQ4
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor ""t0 " Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete. f °
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 $
is not assessed as real property or to a manufactured home tha - of assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile ho ufactured home.
Signature of Auditof w cal
Date SI'ga¢d( y y, ear 2-
•
DISTRIBUTION: Original—County Auditor,File-Stamped Copy— axpayer
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