Homestead_Lasswell at:" CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
1 STANDARD/SUPPLEMENTAL DEDUCTION FORM ��}}
State Form 5473(R19/1-23) HC10 LC�
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(WerThMbflf� 4 t frD /frrti ekg5,,4- d - / certify that I(we)occupied as my(our)principal place of
residence or am( e)buying the following descri ed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, (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.
CLAIMANT'S INFORMATION
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Countv
6GO / P Township,TO /ih Taxing District(ci ,town,to�rp) Al / Kit 1 fi
Parcel Number Legal Description Is the property in question:
th al Property ID 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 at structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
R 7 '//—/4-t IN-pDa. 4 -j . ;.�$;lett,
PROPERTY OWNED ELSEWHERE BY CLAIMANT ` fw
State,C un ,a Towns u / /ill'
��i G I Claim t Vacating a Homestead? ,6 +
((6. Yes No
Sign tore of Claimant
I hereby certify the above statements are true,correct,and complete.
Address of Con.c(j ,v2and street, Cate,and ZIP e)� , + Addr a Vacated Horge stead,
�ifjany(numberand she ,city,St;�ta,and ZIP code) IL-
6yi'ldn N./(niY/� (pL RI l� o� a / C'/1!I r t r ��t( j'rjG�1(6 //
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE /„�4.M
Land Not Exceeding One(1)Acre Immediately (1) , [1/
Surrounding Residential Improvement .
Other Land (2)
Total Land(line 1 plus line 2) (3) ILED
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) (} -
Other Improvements (6) F B 2 8 2025
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)
•
Signature of Assessor Gii40.446firryisSdN )I hereby certify the above is true,correct,and complete. AUDITOR
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 povision,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 anufactured home that is not assessed as real property may not
excee one-half(il2)of the assess alue of th bile home or manufactured home.
Signe re f Audito a lL ji Date Signed(rr/fin ngayrye 0�
DISTRIBUTION:Original—County Auditor,File-Stamped Copy—Taxpaydr 1LII�J''it��'�CL77[1/00���h1��J///////
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