Homestead_McDaniel (3) . . ,'.- CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
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�;•• STANDARD 1 SUPPLEMENTAL DEDUCTION HC10 o2DoR
s . P State Form 5473(R19 t 1-23)
t'e 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.
�" WI r�I ' CERTIFICATION STATEMENT
/L I(We) ESIE 2 I L certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described 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).I(We):
Own. El 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 rvrrrpy the property under the
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTYroiki DESCRIPTION
Couyt� I /t_./'�o T wt yp ,j,l,\/r,,. Taring Dis ct(sty,town fppitj £o/ 7
Parcel Number Legal Description(tlf/ 't{C/�'f,', Is the property in question:
of '/J
• Real Property ❑Annually Assessed Mobile Home(IC 61.1-7)
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 Income.
a6 (9‘ - ( ./ 0200 ,- ) 3 - /7575-0/IT
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Va ng Homestead?
❑Yes No
Signal f Claimant
I hereby certify the above statements are true,correct,and complete. 11/�t 9
r` ,1 - I a
Address of Contact(num Brand t,city,s and ZIP code) Om r,�'`f .cated Homes ea.,if any(number and street,city,slat,a d ZIP code)
8317J > ri _ a .I
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE f NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) i )-':K,fis
Total Land(line 1 plus line 2) (3) VI)
•
Residential Improvements or Dwelling (4) 1 •J!'i1 'r ";
Annually Assessed Mobile 1
Manufactured Home Garage (5) t ��^� I
Other improvements (6)
Wg U ` ���
Total Improvements(Line 4 through Line 6) (7)
, Total Value(Line 3 plus Line 7) (8) fff///��� r w�.''''(('��. .O�
Signature of Assessor ' fir,.. -r: dot�rndrithfybarf 1
I hereby certify the above is true,correct,and complete. .SON C
G
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 that is not assessed as real property may not
exceed on ha(((1/2)ooff the assesse toe of th mobile home or manufactured home. ,.,//��)�//�c��
Signature uditor f Date Signed mo t577 Cl(..�L,ac..!
t j//j I//J�
DISTRIBUTION:Original—County Aud to,File-Stamped Copy—Taxpayer
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