Homestead_Sandusky e/: ; CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
s.';, `i' STANDARD/SUPPLEMENTAL DEDUCTION FORM �y
a my Slate Fonn 5473(R19/1-23) HC70 3 Q .
ri 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 6-1.1-12-3T.
� CERTIFICATION STATEMENT
�T
I(We) YQUI ' A- e nt .X .. &f atus e . certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the followirdgddja�scnb(�rea�l property under contract for whet{a Homestead Property Tax Standard Deduction is hereby claimed on the
daa-�ter rthis application is signed, N- i • rj-� (date of signature).I(We):
LJ C7wn. El 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.l
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County nship Taxing District(city,town,township)
. Y.N. 'V �.a►.TO.)�t s 0 2-
Parcel Number Legal Description (Is he perry in question:
Real 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.
(
`)-k - o (, _ )oc QDl . eQ'---1 . .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Clatma Vacating a Homestead?
Yes ❑No
Sdrta a of Claimant
I hereby certify the above statements are true,correct,and complete.
Address of Contact(number: dstreet,ci state,...ZtP code) Address of Vacated Horn stead,if any(number an treat,city,state and ZIP code
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE .I
(1)
Land Not Exceeding One(1)Acre Immediately % .d.laki
Surrounding Residential Improvement +,
Other Land (2) }%d -.�
Total Land(line 1 plus line 2) (3) (...".
•
Residential Improvements or Dwelling (4) Ty _r` „1.,..
Annually Assessed Mobile/ r ---�
Manufactured Home Garage (5) ;,
}
Other Improvements (6) �
Total Improvements(Line 4 through Line 6) (7) APR01 1
Total Value(Line 3 plus Line 7) (8) B 45
Signature of Assessor 5 ' Date Signed(date, o year)
I hereby certify the above is true,correct,and complete.
Giaq / 1
Verifying Action-Signature of Auditor N CQ J tad(date,month,year) t'�
STANDARD DEDUCTION ALLOWANCE 'T71"`���YYY i �N t1-t.
�1
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000. "'V V v
Notwithstanding any other provision,the sum of the deductions provided in/C 6-1.1-12 to a mobile home that $ N
is not assessed as real property or to a manufactured home that Is not assessed as real property may not
exceed one-half(i/2)of the assessed value of the mobile home or manufactured home.
c
Si nature of Auditor _ . "� 0'ie ^ vd,..„0,---)
�"'� Date Signed(mo_nfh,day,yr a�rg: •
s.....<;:si
DISTRIBUTION:Ori al-County Auditor,File-Stamped Copy-Taxpayer V V
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