Homestead_Simmons (2) = �r CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
4 FORM
' ' STANDARD I SUPPLEMENTAL DEDUCTION ,} ���
State Form 5473(R19/1-23) HC10 !may
• 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) f I Y11 0 Ifr-- " certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the fct Iq:'tit a rt8 d,re.aFprerty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
.ate is application is signed, t - .) (date of signature).I(We):
�1• n. ❑Am(are)buying under recorded contract.
(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.
❑
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
[�""�j{^j� PROPERTY DESCRIPTION
County Township `/ L.- Taxing Districtt�wn,fo gh/p
L.J i v 1
Parcel Hum Legal Description I property in q estion:
Real Property 0 AnnualyAssessed Mobile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately Burro that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
26- \ 1 -zol---1 I -coo o 117 -- Q 2)
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township . Is Claimant V. •./!estead?
❑Yes 'n'No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete. / .,,
Address of Contact/nu •- :nd street,city,state and code) AUMe acated Homestead,it any(number and street,city,state,and ZIP code)
Q '" n, �mni �` \v,) i
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately ` (1)
Surrounding Residential Improvement q
Other Land (2) * ,<,
u_
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) 4pe #`
Annually Assessed Mobile/ T
Manufactured Home Garage (5) 1 ft 1
Other Improvements (6) Qf (. ,x i
Total improvements(Line 4 through Line 6) (7) St
f Cp 2
.t f .
Total Value(Line 3 plus Line 7) (8) 4/4„' ,
Signature of Assessor .4g4). Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete. lt',9
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 $ e
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 assessed value of a Mb-Di home or manufactured home.
Signatur of acid - Date Signed prrfither, ear) )...---- -
DISTRIBUTION:Original—County Auditor,File- opy—Taxpayer
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