Homestead_Kelley (10) •
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
F
STANDARD I SUPPLEMENTAL DEDUCTION ORM �.
,\ State Form 5473(R19I 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) er /Pgre .r6.1_(^ certify that I(we)occupied as my(our)principal place of
residence or a are)buying the foll.viii •des red r•.I•roperty under contract for which a Homestead Property Tax Standard Deduction Is hereby claimed on the
ate this application is signed, t 150• - (date of signature).I(We):
Own. DAm(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.
/„ ��� "`eC_ •� /Recorder's Office Where Contract is Recorded Record fit ON O ' w /
ouN 'r-` f'i/�
•
PROPERTY DESCRIPTION
Co ?ship Taxing istric city,town, . nship)
�1 ° luCC U r 5a f�rl�scL.14 .
Parcel Number Legal Description ��rIsstt/h/e property in question:
fff pCl Real Property ❑Annually Assessed Motile Home(IC6-t.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?
❑yes k.CNo
Sign a of Claimant L� , 1 } fi r' �,,�
I hereby certify the above statements are true,correct,and complete. 1 J_ 1��^/'
Addr ss o Co it t(nu rand st e, ty,state.an 2 de Address of Vacated Ho Lead,if an (number d street,city,state,and ZIP code) G,k
�1 ��MO , . ') ginrt i0 o
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) ;':
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) F ri
Other Improvements (6) 4,','''..- ,t
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete.
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 one-half(1/2)of the alue of t mobile home or manufactureld home.
;tUfitoj / & j4/ , Dat,DISTRIBUTION:Original—CounileStamped Copy—Taxpayer
6`
Page 1 of 2