Homestead_Nguyen CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a STANDARD!SUPPLEMENTAL DEDUCTION FORM
's State Form 5473(R1911-23) HC10
'r1° Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for firing 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) #) certify that I(we)occupied as my(our)principal place of
residence or am(are)iuyiag th f Ito 'n r(bgd �hprog; ty un6BT ontract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date is applicatidh is signed, ll r� [kg lob rate of signature).I(We):
Own. ❑ (are) uying 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.
❑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
Count �bq� Township ^_.-� Taxing District(city,town,town l Parcel /"-
Parcel Nu e n a Legal Description Is he roperty in question:\ •
eal Property ❑Annually Assessed Mobile Home(IC6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately sufrd ds hat structure is used to produce income,describe the use and portion
of the property utilized to produce income.
---- LI E 03_00 0 4.mg 1 _ 0
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
❑Yes ❑No
'Signatur of Claimant
I hereby certify the above statements are true,correct,and complete.
Address of Contact(number and street,city,state,a^n`dd,ZIP(/co Address of Vacated H//^ Weed,if an (numb.rand street,city,state,and ZIP code)
1 1Ati 0 S 1' V c �1 4-t` V c o.
ASSESSOR USE ONLY I 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 Improvements or Dwelling (4)
Annually Assessed Mobile t '
Manufactured Home Garage (5) '
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (6)
Signature of A a.sot / 9 ,, Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete. p tI <2�
Verifying Action-Signature of Auditor "�V_(1O �v Date Signed(date,month,year)
V - _ •
STANDARD DEDUCTION ALLC'.VANCu-.
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000.,
•
Notwithstanding any other provision,the sum of the deductions provided in IC 6.1.1-12 to a mobile home that
is not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile nufactured home.
Signature ofC'�� Date Sign (ma h,r$aY, a )
DISTRIBUTION: Original-County Auditor,File-Stamped Cop - payer
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