Homestead_Ross (8) "7"'-'' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t :,J;'`1. STANDARD t SUPPLEMENTAL DEDUCTION FORM .
•?, Ir. State Form 5473(R19/1-23) 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 64.142-37.
���A/^,y, CERTIFICATION STATEMENT
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I(We) 0%Y/e� 'W certify that I(we)occupied as my(our)principal place of
residence or ern(are)buying the foi w n escri �,reya�l pro rty under contract for which a Homestead Property Tax Standard Deduction Is hereby claimed on the
date this application is signed, !7`4'O�-t (date of signature).I(We):
XOwn. 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
Cou I�t/ J Town Taxi•, ct ci tow hipJ alert/ •�
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Parcel Number .: ►escdption Is the property in question:
�� Real Property ElAnnuallyAsnwmed Mobile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not e - ii g�bn ( a e that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
-l01,-0 /-1- (D1_ors T. 9 7- 8
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Stale, ou and T ns ip /� Is Claimant Vaca'ng Homestead?
/K./`7 Signs. of Claimant ❑Yes No
I hereby certify the above statements are true,correct,and co plete. /////� f I�
A e/vs�of r ont o( m erarr1 s set,ci j/st/aat"e',an 2l code Ala-7
ref�'''/ r!"dress of Vacated Homestead,it any(number and street,city,state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE 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 I
Manufactured Home Garage (5)
Y 2 o zo25 , ,
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (5)
GIBSON g� •'
Signature of Assessoral�1� �
I hereby certify the above is true,correct,and complete.
Verifying Action-Signature of Auditor 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 manufactured home that is not assessed as real property may not
excee one-half(1/2)of the asses value of t ob/ileehho�mt�ee or manufactured home. g Signs re to 'o /'I""�'"" Dal ed(J th,day. ear C—(:)\.
/L "/~J �
ISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpa4r
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