Homestead_Collins &IA CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
(CAA- a STANDARD I SUPPLEMENTAL DEDUCTION FORM
.'.nlitillIV State Form 5473(R19/1-23) HC10
Jai 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)._S(4e...e= ap3.RAJN1£1 4. It s. certify that I(we)occupied as my(our)principal place of
residence or am(- uyingrie f. .ollowin chR5ibeg021.property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date,SrapplicatIon is signed, LA* (date of signature).I(We):
DiOwn. IDAm(are)buying under recorded contract.
0 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.
0 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 Taxing District(city,town township)
Parcel Number Legal Description Is the pro rty in questi .
eal Property 0 Annually 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 surrounds that structure Is used to produce income,describe the use and portion
of the property utilized to produce income.
0 1.0.../CQ.... -D-7_ Ica_ oco. 1 CZ- 0\"---7
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claiman s•ting a Homestead?
es 0 No
.,, Signaler-of Claimant ...
I hereby certify the above statements are true,correct,and complete. ,,.."
.11 •
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-
.." , - " AIL-.. .....r
Address of Contact(number and street,city,slate and ZIP cede),% Addr-:;',..:(Vaca ed Homestead,if any(n /•er an•'.-reet,city,state,and ZIP code)
.....‘A-10 :1›.-C i at a k Y d Val Wait40V\• -' M • 4 . earthp -. 8 IA t IP'a.\--14.7 (60y)
,
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE 1 HON-RESIDENTIAL VALUE
Jt4 ,Land Not Exceeding One(1)Acre Immediately (1) . , .
Surrounding Residential Improvement
Other Land (2) ,.. ' : :'-• : i ',:, '' Lt1LOL\0
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) Firt-t
71)
.. ,
Annually Assessed Mobile/
Manufactured Home Garage (5)
-...§*
Other Improvements (6) AP 3 0 '• '.' ' ' - - ..7-
Total Improvements(Line 4 through Line 6) (7) 2025
Total Value(Line 3 plus Line 7) (8)
>2.4..c.f./4eee
Signature of Aw ftf 7....1 . Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete. ( SO CO 1
*.COu ' bk...zei._ i.
8
Verifying Action.-Signature of Auditor Nry Date Signed(dale,month,year)
Aubradf,_
,oR
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STANDARD DEDUCTION ALLOWANCE 1
t"..
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000. CIS
1
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $
2
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.
Date
Signature of Auditor Signed(month,day,year)
L.,1lk-- 0
DISTRIBUTIOIN:Original-County Auditor,File-Stamped Copy-Taxpayer
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