Homestead_Douglas III v,_"R CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
MI
• State Form 5473(R19/1-23) HC10 MI
i-i 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) (a,S certify that I(we)occupied as my(our)principal place of
residence or am(art .uying the 1ltow"i re prePQl der contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
dal is application is signed. ((.,.%(date of signature).I(We):
Own- DAm(are)buying under recorded contract.
❑ (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.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township T�� Taxing District(city,Ci shi . l(t{c '
Parcel Num.=r Legal Description�jl the perty in question:
4
Real Property ❑Annually Assessed Mobile Home(IC 5-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately sur nit that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
(2,,,L ....... \—I ....— )1...—. (2/02.... ,--- 00 0 4 S7D 71c .---CD 2:?...„
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacatt a Homestead?
❑Yes , to
Signatuia,/�
I hereby certify the above statements are true,correct,and complete. tI�
Address of Contact(nymb. and rest,cite,find IP code) f— i ddress of Vacated Homestead,if any(nu er and s city;slat ZIP code)
N UNCQ 1
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)
Total Land(line 1 plus line 2) (3)
Residential bts or Dwelling (4)
Annually AssessedH Mobile/
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) MAY 01 2025
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete. //�, - L
f
Verifying Action—Signature of Auditor GICOUNTY All�..TD I I OR Date Signed(date,month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 648,000,
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 mob nufactured home.
Signature of Ay it r" 1 Date Signe onth,1day,year) ,
DISTRIBUTION:Original—County Auditor,File-Stamped y—Taxip ye \ 1 �
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