Homestead_Wiggs d • i CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
n' '- ': STANDARD I SUPPLEMENTAL DEDUCTION • FORM y`
State Form 5473(R19 i 1-23) HC10 Q`
'j' 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) ' M V v i • certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the foil j�((e,s$gbed at e nder contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date thi placation is signed, —ip2 4" . (date of signature).I(We):
❑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. ,
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION 0 4
Cou To nship Taxing District(city,town,township) ���VVV
-►b Star . o1v(,i- bi(k . _ +iv.i. b 10: -
Parcel Number Legal Description I� rf
gtE=property in question:
�MI Real Property 0 Annually Acsasned Mobile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediatei .unnun.s that structure Is used to produce income,describe the use and portion
of the property utilized to produce income.
1 -- lt-k- \ a -.1.-t OD -.Doc -CEO Lo
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Ho stead?
❑yes No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete. Lt.) '
404*
Address oof_CContact(number and sttrreeet,city,state,and ZIP code) Address of Vacate omest ad,if any(num�_ met,city,state,and ZIP code)
sp
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE !NON-RESIDENTIAL VALUE '
Land Not Exceeding One(1)Acre Immediately (1) c : e"'
Surrounding Residential improvement t . ;:;,
Other Land (2) , :,
.+a v. x. _. . ,
Total Land(line 1 plus line 2) (3) •
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
ay;
Manufactured Home Garage (5) «•,�"* y a
Other Improvements (6) i. r :""i APr? 2 9 2o2
Total Improvements(Line 4 through Line 6) (7) I{�j,,\
Total Value(Line 3 plus Line 7) (8) lr _ / ` II
4111
Signature of Assessor GJBSO'N E igrrldtriet� )
I hereby certify the above is true,correct,and complete. CO 'y�Y1/n T
Verifying Action-Signature of Auditor Dale Signed ciPet (uIF 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
.C4
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor .. Date Signed(month,day,year)
- k-.6 iNQ_A__Q. -0- 83- w\- 1-k-. ..q- Q .
DISTRIBUTI•N:Original-County Auditor,File-Stamped Copy-Taxpayer
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