Homestead_Smith (30) e .- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM HCO OZ�_
•., _-! State Form 5473(R19/1-23)
;r Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for Nino 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) Q, 4) ti -, 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
dateil�, this application is signed, y-. •Z�• (dale of signature).I(We):
L�'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.
If Buying on Contract,Fee Simple Owner's Name
t--,l
Recorder's Office Where Contract Is Recorded Record Number Page
PROPERTY DESCRIPTION
Counnt�y �("� Township •..r� r y, Taxing District(city,town,tonal
\6, \ 1 . c�k�o,>y •e- Lt �,
Parcel Number Legal escriptio `1f Is the property in question:
eal Property 0 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 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 o
'Signature ofCh,. ant 7-7
I hereby certify the above statements are true,correct,and complete. ia{J\tat um e f/��a/'�
Addre c r and street,city,staCte -:
,and ZIP code) Add of Va tetr dHomestead,if any(npumbera dstreef.city, ZIP code)
ASSESSOR USE ONLY ( ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1) x;Y `+-'. 'I
Surrounding Residential Improvement . „t_, ,_, _-.
Other Laird (2) >a. ix s,
Total Land(final plus line 2) (3) V r
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) s "�r '
APRF .
4F 2025
Other improvements (6) li z •
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8) GIB SON rG , y�
Signature of Assessor 661et igpeAtft)�g{ -t ear)
I hereby certify the above is true,correct,and complete. f
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 of to a manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home. /
Signature ofAuu; el -�('` _ Data Signed(month,day,ya (..
ilk
DISTRIBUTI :Original-County Auditor,File-Stamped Copy-Taxpayer
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