Homestead_Faith (2) CLAIM FOR HOMESTEAD PROPERTY TAX _ _
YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORM
.„.. State Form 5473(R19/1-23) HO10 noD$
• ,,,, 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) >-0 f\4-44-0—n t-t. • ck.mir\. certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the followIng describe real under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date ti>application is signed, „0 I'4— .. (date of signature).I(We):
IrEOwn. CI Am(are)buying under recorded contract.
0 Am(are)entitled to occupy ass tenant-stockholder of a cooperative housing corporation.
10 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 i Township Taxing District(15w4lownship) •
be5On • MO r -k$Z30 men 1.--\ •
Parcel Number Legal Description ... Is thety 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 surrounds that structure is used to produce income,describe the use and portion '
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
0 Yes 111-1‘......
Signature of mast
I hereby certify the above statements are true,correct,and complete.
Address of Contact(numberand street,city,state,and ZIP code) Addreg- acute.Homestead,if any(number and street,city,state,and ZIP code)
ag3 . 6 . k,..3. •u-Oc-s6 `it e._ m .
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)
Total Land Land(line 1 plus line 2) (3)
LEI) 1
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6) 7.7,:-:;,,:- , .Ni- EE/
' ','','-';--''' . . -
4 Ut5Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8) tr-Nim‘szt.r..3
ii4e.cri-7-(".
Signature of Assessor C Oar,,,,... C,Ot2#1(date,month,ye '
I hereby certify the above is true,correct,and complete. ‘-•JUivri,
Verifying Action-Signature of Auditor .Date44014ity .
onfh year)
rf
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 too mobile home that $
is not assessed as real property or toe manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor y,., ned(month,day,year)
Date Sig. - iik-a.
03,,,
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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