Homestead_Hasselbrinck (6) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
(4.. :,./' STANDARD/SUPPLEMENTAL DEDUCTION FORM
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..;;-• ;,. State Form 5473(R19/1-23)
s Prescribed by the Department of Local Government Finance
INSTRUCDONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 64.1-12-37.
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CERTIFICATION STATEMENT
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I(We) ‘O.. / r N\yil certify that I(we)occupied as my(our)principal place of
rest ce or am(are)buying the f II by.1 bi2:creStroperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
this application is signed, (date of signature).I(We):
Own. 0 Am(are)buying under recorded contract.
El (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial Interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
I:I Am(are)the shareholder,partner,or member of the entity that owns the property.
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CONTRACT RECORDED
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If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
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' PROPERTY DESCRIPTION
. County ,,,\ Township (32... Taxing District(city,town,towns m)
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Parcel Number Legal Description s th roperty in question:
• Real Property 0 Annually Assessed Motile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately surto that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
2C --- vck _o _ too- Dot.
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
. .. State,County,and Township Is Claimant Vacatirmastead?
I 0 YOS IN D
4 Si ure of Claimant
I hereby certify the above statements are true,correct,and complete.
Addr sDCoetdctcber and street,city,state,and ZIP code) Nr ,d estlft:Id Homestead,if any(number and street,city,state,and ZIP code)
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ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
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Land Not Exceeding One(1)Acre Immediately (1}
Surrounding Residential Improvement
Other Land 2) . . ,::: .'A•:::', .'=,:, -,i'l
;. ''.`..,=.`;,‘'n't,,:;.-.:,,-1.,
Total Land(line 1 plus line 2) F ila 31:44)
Residential Improvements or Dwelling 4
Annually Assessed Mobile/
Manufactured Home
APife 2 3 20ii
Other Improvements
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line VakeAree.e.r2 .40)
CISSONCOthrty 4; ;214/Assessor Date Signed(date,month,year)
I hereby certify the above is true,correct,and oompletAUDITOR
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Verifying Action-Signature of Auditor Date Signed(date,month,year)
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STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the hoinestead or$48,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home that $
is not assessed as real property or to a manufactured home that is not- essed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or :. red home,
Signature of Auditor / Date t‘ed sn2ye4.1 („1..)
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DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpaye _
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