Homestead_Cromer CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
'f STANDARD 1 SUPPLEMENTAL.DEDUCTION FORM � _
1 State Form 5473(R19/1-23) HC10 2_3
`•"Cf 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 6-1.142-37.
CERTIFICATION STATEMENT
I(We) 1 V I ' ''1t-A • certify that I(we)occupied as my(our)principal place of
resides .or am(are)b t ing the f..,i,••a tl d7ea operty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
•ate application is signed, t"" G4.• (date of signature).I(We):
i,•wn. 6Am(are)buying under recorded contract.
A (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.
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page ,
PROPERTY DESCRIPTION
County .›A ' Townshipill 0 y lit Taxing District(city,toms township) 1t
Parcel Number Legal Description t e prop• ` n question: v t
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 su un s that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
2.0...----• 2,C „.-- \. Ir. .____,..3 0 0 ---. C:31 0 0(03 1....1 ..--- 0 0‘
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati a omestead7
❑Yes No
Sigr�a�u ,af Claimant n
r�
1 hereby certify the above statements are true,correct,and complete. � r // /y'
Address -o of Contact(number and street,city,stat-e�,and ZIP code) Address of Vacated Homestead,if any(number an street,city,state,and ZIP code)
105R) e c)- t
S i , % ' k^,,DY) — i •• e (/,`ems
ASSESSOR USE ONLY ( ASSESSED VALUE/� HOMESTEAD VALUE NON-RESIDENTIAL VALUE
LandrrNot Exceedingeside One(1m)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/ 444!y 0
Manufactured Home Garage (5)
Other Improvements (6) S CO
Total Improvements(Line 4 through Line 6) (7) Q/eS0
Total Value(Line 3 plus Line 7) (8) °O AI
Signature of Assessor �'r' � Date Signed(date,month.year)
I hereby certify the above is true,correct,and complete. (�
Verifying Action-Signature of Auditor O,TO' 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 horn:.. factured home.
Signature of Auditor — Date Sigr f'( ont day yea
DISTRIBUTION:Original—County Auditor,File-Stamped Copy—•- . `
Page 1 of 2