Homestead_Hensley (8) iiientEllili
CLAIM FOR HOMESTEAD PROPERTY TAX I FORM
:' STANDARD/SUPPLEMENTAL DEDUCTION HC10 Mil
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 IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) r I i._i�.43.— 4>tr-. f 1.. \ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the Tolle�+ing descn•.d real gperty loader contract for which a Homestead Property Tax Standard Deduction Is hereby claimed on the
date this application Is signed, l —I (date of signature).I(We):
n O Am(are)buying under recorded contract.
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 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.
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township ry. l2 Taxing District(city,town,township)
Parcel Number Legal Description 1 Is the property in question:
Real Property Q Annually Assessed Mobile Horne(IC 6-1.1-7)
If 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 income.
r'Q— \\ \Q— _ o - . f:1- '--\— 0 .�*---7,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacatinga Homestead'?
Dyes Al No
Srgnature ��'111
I hereby certify the above statements are true,correct,and complete. 0 -//P.,��r
Address of Contact(number end street,city,state,andr'�ZIP code Addre f Vaca •H.mestes,iAi any(nnuum`ber and sheet,city, e.and ZIP code)
4 �. o>��s,D - rC r ,i• • _ • 4
11011
I ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land NotI(mprrooveemenntt duty (1) �
-1c:)
Other Land (2) J�
Total Land(line Y plus line 2 (3) • ���•••'r/''"'"" `rX4
Residential Improvements or Dwelling (4) r`i'-'` +4 Annually Assessed Mobile/
Manufactured Home Garage (5) � , ---
Other Improvements (6) - - - dry/
Total Improvements(Line 4 through Line 6) (7) /7 ,.YJ °12.�11�
Total Value(Line 3 plus Line 7) (6) • �(r'��(��1�-`'
Signature of Assessor • ._.( e,month.year)
St►
I hereby certify the above is true,correct,and complete. t��
Date Signed(date.month,year)
Verifying Action-Signature of Auditor
STANDARD DEDUCTION ALLOWANCE !1�
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000. `1 �v
Notwithstanding any other provision,the sum of the deductions provided in lC 6-1.1-12 to a mobile home that $ \` JJ\
is not assessed es real property or to a manufactured home that is not assessed as real property may not \\`J
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor 1,� �, _�, , Data Signed(month,day,year) (� j
DISTRIBU N: Original-County Auditor,File-Stamped Copy-Taxpayer
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