Homestead_Keener ate'"g CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' ' STANDARD I SUPPLEMENTAL DEDUCTION FORM
}:Y, •-,v+ State Form 5473(Rig t 1-23} HC10 ♦�
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.
` 1 �� CERTIFICATION STATEMENT
((( S e[\1 I(W I"�i�Wv") { " C�CA certify that I(we)occupied as my(our)principal place of
resid- buying the i nbed I prppert}wnder contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
`dda his app Ica ion is signed. ) (date of signature).I(We):
gOwn. Am(are)buying under recorded contract.
❑ (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.
❑
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County _.SO
�^1 Township ^ �� Taxing District(city,town ship)
Parcel Number { i Legal Descrptttiio`nn\j s th roperrt Property -n:
❑Annually Assessed Mobile Home(IC 6-1.1.7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surto n that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
2_6_2_0 .�` l - L102 - o, \ - --co
2
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vaca g Homestead?
❑Yes No
Sig Durao r Claimant M- I `�_ +_ e�
I hereby certify the above statements are true,correct,and complete. y+a,� '/1� J r w-_
Address of Contact(number and street,city,state,end ZIP e) Address of Vacated Homestead,if any(number and street,city,state,and ZIP code)
1 ' Juon St" 0 . 11 I . .
ASSESSOR USE ONLY I ASSSSSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One('I)Acre Immediately (1) .
Surrounding Residential Improvement
Other Land (2)
i
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile 1 ,/�/ .- r
Manufactured Home Garage (5) "7 r
Other Improvements (6) (. , ,
Total Improvements(Line 4 through Line 6) (7) %% c J
Total Value(Line 3 plus Line 7) (8) o "
Signature of Assessor �'rC; .,bete Signed(date,month,year)
I hereby certify the above is true,correct,and complete. 'v'` —
c�
Verifying Act on-Signature of Auditor f'Cv t a(e.igned(date,month,year)
h/.
t
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 moot ome anufactured home.
Signature of Auditor ' ; Date Sigrfga(mg th, year
DISTRIBUTION:Original-County Auditor,Fite-Stamped Cop r
Page 1 of 2