Homestead_Byers (5) •
. % CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
►; STANDARD 1 SUPPLEMENTAL DEDUCTION FORM ^
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•am - �• State Form 5473(R19l 1-23) HC1g
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) 1A,TIPC\ S certify that I(we)occupied as my(our)principal place of
rest once or am(are)buying the f II g, oWoeti mal�rty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
d this application is signed, 1. FD C. (date of signature).I(We):
Own. CI 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.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County ! /"� Township ,!- Taxing DistriC r , wn,township)
Parcel Num er ✓\ Legal Description '(,J( Is the •pertyin question:
ce,Real Property CIAnnuattyAssessed Mobile Home(IC 6-1.1-7)
i
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sur-.•tit ,hat structure is used to produce income.describe the use and portion
of the property utilized to produce income. 'w
C
— 1 — � - 000 • S\\�— ozl
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vaca'Homestead?
❑Yes a No
Sign re o
I hereby certify the above statements are true,correct,and complet
A••ass of Contact(number ends reel,city,state ZIP code) Address of Vacated Homestead,if any(number and street,city,state,and ZIP code)
;2Z2- ' S • T >� r\-ka- s .
ASSESSOR USE OM? I 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) Fi4 ,
Annually Assessed Mobile t
Manufactured Home Garage (5) t
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) �r
Total Value(Line 3 plus Line 7) (5) S
Signature of Assessor OM,
Date Signed(date,month.year)
I hereby certify the above is true,correct,and complete. t5(�
Verifying Action-Signature of Auditor CO& -"` Date Signed(date,month,year)
40, •
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 ho t a J of assessed as real property may not
exceed one-half(1/2)of the assessed value of the mob' h e or hr nufactured home. '
Signature of Auditor Date Sig ed(moat IL);r)
DISTRIBUTION:Original-County Auditor,File-Stamped opy-Tax er
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