Homestead_Hoffman •
a%,.."' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR ,
I' -.:- 1s STANDARD/SUPPLEMENTAL DEDUCTION FORM
*a\ ) State Form 5473(R19/1-23) NC10 r
I IS 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) "V ' ,/ • -, i,, In certify that I(we)occupied as my(our)principal place of
residence or am(am)buying the fotfowin d ri ed r t erty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, � � (date of signature),I(We).
' Own. El Am(are)buying under recorded contract.
❑Am(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
County-� Township 11' Taxing 0. '"«�}s.rr: rp)
CaqintEt
Parcel Number Legal Description Is the property in question:
Real Property ❑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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
&-•- 6 4-/i- ll -soo . 0 1/l9/g
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
❑Y El No
Signature ofCla'
I hereby certify the above statements are true,correct,and complete. }
Address of Contact(u ber and street,city,p'',and ZIP code) Addr acate tea (number and street,city,state,and ZIP code)
4 s .too :tug/A. ' 7 ,
ASSESSOR USE ONLY ASSESSED VALUE j HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) Ai
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) -`
P ,,,,.„
Annually Assessed Mobile I .., ,
Manufactured Home Garage (5) ii , .
Other Improvements (6) �14Y.ii '/T 9 .
Total Improvements(Line 4 through Line 6) (7) ^"+rC5
Total Value(Line 3 plus Line 7) (8) �/
Signature of Assessor G18 ON to S ect a ,month,year)
I hereby certify the above is true,correct,and complete. CO
Verifying Action—Signature of Auditor Date Signed' eitS eer)
•VVR
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 64.1-12 to a mobile home that $
is not assessed as real property or to a manufa red home that is not assessed as real property may not
exceed one-half(1I2)of the asses ed value o the mobile home or manufactured home.
Sign. r .o A i,' , r
- e 1 Date S'ned(m t,d ea
/ i i
DISTRIBUTION:Original—County Auditor,Fite-Stamped Copy—Taxpayer
Page 1 of 2