Homestead_Ireland CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
A i STANDARD/SUPPLEMENTAL DEDUCTION FORM ,���
• State Fenn 5473(R19/1-23) HCI I)
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
I(We), jf' ' )i . " O(. s' an + certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the followin•described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date i application is signed, (date of signature).I(We):
Own. ❑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 tens of a qualified personal residence trust.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
If Buying an Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township�`Tpti�n^— Taxing District(city, • ,township.
Parcel Numb Legal Descrio Is the p•,.- �•uestion
0 Real Property ❑Annually A sassed Mnbile I kw.w(IC 6-1.1-7)
It any portion 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 property utilized to produce in \s 1
'PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is Claimant Vacating a Homestead?
' ❑]Yes
�� No
SJgyetu of Clai`:nt r `5�\'v""_'
I hereby certify the above statements are true,correct.and complete. 4r` �(17
•i Contact(number and street, '. state,ani P code /'' Address of Vacated•_.es ead,if any(number and street,ay,state,and ZI ••e) '
( •
NW
ASSESSOR USE ON'_Y ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALHE V
Land Not Exceeding One(1)Acre Immediately (1) C ,
Surrounding Residential Improvement
Other Land (2) T■ ,
V
■
Total Land(line 1 plus line 2) (3) rOResidential Improvements or Dwelling (4) ■■■iii 0
Annually Assessed Mobile/ (^+�
Manufactured Home Garage (5) 0r�C ti„J
Other Improvements (6) 1 pN LJ
Total Improvements(Line 4 through Line 6) (7) J F1 •
r1
Total Value(Line 3 plus Line 7) (8) th L I a.
Signature C t4""'AUDITOR Date Signed(date,month,yea) 1
I hereby certify the above is true,correct,and complete. GIBS COS
Verifying Action—Signature of Auditor Date Signed(data,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/C 6-1.1-12 to a mobile home that $
is not assessed as real property or to a manufactured e that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of bit me or manufactured home.
Signature or tar r-�, ,.�^'1 .. Date q �p yq,tlay,yq@ ,
DISTRIBUTION: Orriggiinal\`—Coun�y Auditor,File-Stampe y— payer ()/_/`/-` '')L
Page 1 of 2