Homestead_Naas (17) a�"•rt���' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
?' ` I STANDARD/SUPPLEMENTAL DEDUCTION FORM
b 1 State Form 5473(R19/1-23) HC10 2
' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instnscfions,
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
- CERTIFICATION STATEMENT
71 �‘
I(We) IP al\,- t C ‘C • certify that I(we)occupied as my(our)principal place of
residen 'or am(am)buyirg the following d rU r@a ropgfty�ur oerr contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
dat 's application is signed, f�(t++ GG ate of signature).I(We):
Own. ❑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.
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County v' `,\,/"� Township /'�i Taxing District(city,town,township)
Parcel Number Legal DescriptionJ) Is lh property in question:
Real Property ❑Annually Assessed Mobile Hare(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately s n that structure is used to produce income,describe the use and portion
of the property ut'zed to pro e Income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
❑yes ❑No
Si ure f CI' 4,„---1
I hereby certify the above statements are true,correct,and complete. r
Address of Contact(number and street,city,state,and ZIP code) r s of V sated Homestead,if any(number and street,city,slate,and ZIP code)
2S-'d 0.s Yt_-G 27 - .t; _ - - `(— '---‘3 l
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE 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/
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value 7)Line plus 3(Line8
O
Signature of Assessor A ale Signed(date,month.year)
M
I hereby certify the above is true,correct,and complete. lr 2 (V�J�
Verifying Action—Signature of Auditor 5 Date Signed(date,month.year)
STANDARD DEDUCTION/:i.CCW);:•!Cf:
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000. OU/!✓
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that'�''141t./o,
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.
Signature of R dor Date Signed(mo th, ar) r'1 ,.^^"'mM
A 0 Ce'l„VN— (''''''''""—** i ....> i
DISTRIBUTION:Original—County Auditor,Fite-Stamped Copy— 53 ayer
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