Homestead_Johnston a '' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r`".);. 11 STANDARD/SUPPLEMENTAL DEDUCTION FORM
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' State Form 5473(R19I1-23)
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 8-1.1-12-37,
CERTIFICATION STATEMENT
I(We) 41.0..s.t.1 7�.t,y� Y1' ?"t Q('\ 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
date this application is signed, U1 (date of signature).I(We):
If Buying on Contract,Fee Simple Owner's Name -
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Comity Township Taxing District(city,town,township)
Parcel Number Legal Description Is the p rty in question:
Real Property 0 Annually Assessed Mobile Home(IC 6-1.1-7)
It 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.
@ -\- ' Do -'\0- DCp . i tq
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Hag tead?
❑Yes q.C7O
Signature of Claimant
I hereby certify the above statements are true,correct,and complete, !, r_Z,N,L_+xjJg I,fir ,
Address o�tact tuber a..street,ci. state,and TIP code) Address of Vacated Ho stead,if any(number and street,city,state,and ZIP code)
'rQ. =r •`-&1 -,I \S
ASSESSOR USE ONLY ASSESSED VALUE ' HOMESTEAD VALUE NON-RESIDENTIAL VAL
Land Not Exceeding One(1)Acre immediately (1)
Surrounding Residential Improvement 4T '
Other Land (2) r o"j
Total Land(line I plus line 2) (3)
Residential Improvements or Dwelling (4) 515 �,j�
Annually Assessed Mobile/ ,Y `
Manufactured Home Garage (5) ('t` :� °
Other Improvements (6) J�
Total Improvements(Line 4 through Line 6) (7) - Ql�011
Total Value(Line 3 plus Line 7) (8) GWC! tJ LNV��iiiiirA�
Signature of Assessor Date Signed(date,month,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 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.
ts%Signature qi Auditor a j� Date Si red(month,day,year)
4133
DISTRIBUTI N:Original-County Auditor,File-Stamped Copy-Taxpayer
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