Homestead_Johnson - CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
FORM
STANDARD/SUPPLEMENTAL DEDUCTION �►
y �+ State Form 5473(R19/1-23) HC10
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) 4 or `r ' t , certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the foil' -,••icri d real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date.is application is signed, _ (data of signature).I(We):
vz Own. ❑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.
❑Ant(are)the shareholder,partner,or member of the entity that owns the property.
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Townsh \�( Taxing District(city, 16• ship)
Parcel Numb, Legal Description (\ th roperty in question:
Real Property ❑Annually Assessed Mobile Hone(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately sumo d that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
(.2)0 \ \LI
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati •a Homestead?
❑yes No
gn re of Clai 41111
I hereby certify the above statements are true,correct,and complete.
Address of Contact(number and street,cf:,state,and ZIP code Ad ass of Vacated am teed,if any(number and street,city,state,and ZIP code)
moo S .. ,.Y\ s •� ,.�c14 .I
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre immediately
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)
Other Improvements (6) APR 2=.8.,2025°
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8) y27il aJil/C/ t `pi y,�
0
Signature of Assessor GIBSONCOUNT? ODfi'ORmonth,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 toe manufactured home th not as eased as real property may not
exceed one-half(1/2)of the assessed value of the mobile me or ufa d home.^
Signature of itor, ' 01/4.4 Date Signgm ,day, ea
DISTRIBUTION:Original—County Auditor,File-Stamped Cop x er
Page 1 of 2
