Homestead_Rowe CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
V..•1:1ii STANDARD I SUPPLEMENTAL DEDUCTION FORM
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...;• . ,i,• State Form 5473(R19/1-23)
I,II 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 64./-12•37.
CERTIFICATION STATEMENT
I(We) In'Vi-Ph C lib\N<,, , certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the feint , rsaffroPerty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
a this.application is signed, (date of srgnature).1(We):
Ant- El Am(are)buying under recorded contract.
El Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
El Am(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 Township o 0 Taxing Distil, (city,t.. rt,town ip)r4
_501\
-
Parcel Numb Legal Description 1 Is e perty in question:o
al Property 0 Annualy Assessed Mobile Horne(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrou s at structure Is used to produce income,describe the use and portion
of the property utilized to produce income.
O . (-\ VS —0 DC
.
.„......
PROPERTY OWNED ELSEWHERE BY CLAIMANT
P
State,County,and Township 'Is i at Vacati g ornestead?
1
Yes o
St .ur..111(aim nt • ,..C....-..."
I hereby certify the above statements are true,correct,and complete.
/ -
Adlesslif Contact(numberqtstrflifty,state,and ill,code) G fdrlsActil Homestead if any(number and.street,city,state,and ZIP code) ...-...J
—S 01 0 -.DA
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON•RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement . ...
Other Land (2) . , ,,, . •
1 .,• . 0
Total Land(line 1 plus line 2) (3) a
Residential Improvements or Dwelling (4) ^
Annually Assessed Mobile/ 4 PR 2
Manufactured Home Garage (5) U 0 202,„.;.',.':.; ' :',r. -,
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8) ....ttivii,t,44
Signature of Assessor ilik*E1(date,month,year) •(5.-
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 homesteader$48,000.
Notwithstanding any other provision,the sum of the deductions provided in/C 6-1.1-12 to a mobile home that $
is not assessed as real property or foe manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mo ' a or manufactured
Signature o A home.uctter' 007 Lle•Sign (mord da= ....._l\\'--7- ,
DISTRIBUTION:Original-County Auditor,File-Stamped Cop ,
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