Homestead_Beel • -"-j4-N.,, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,
0, STANDARD!SUPPLEMENTAL DEDUCTION FORM
*. _21, State Form 5473(R19/1-23) HC10
*itii, . 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) .. A prnAS p 1.•(7•67 certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following descryed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this a lication is signed, Go 4> 02, (date of signature).I(We):
Own. 0 Am(are)buying under recorded contract.
0 Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
El Am(are)the shareholder,partner,or member of the entity that owns the property.
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taxing District(city,town,township)
1 4507-1._ 2/Y)m-ficii)erj -772292 1-9‘)/27ar 4
Parcel Number Legal Description its the prope ' stion: (/
242-1 0--34 '''' liat)^OCIn. Ceee,-DG2-1 ifiperty ID Annually Assessed Mobile Home(ICS-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.
-''../.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
0
State,County,and Township Is Claimant Vacating a Homestea ?
ID
C
Yes o
Sign " ant b"..(2/( Ll',
I hereby certify the above statements are true,correct,and complete. C2.17 cel-.4 C11
CD
Cs.1
Address of Contact(numberanefreel,ally,slate,and code) Address of Vacated Homestead,if any(number and street city,state,and ZIP
Ns
iliO S ( 3 L C el Ole-,Y\ ---1-\ -C‘) ' lf CO
C=1
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL V."'' , C.
•
. ..
Land Not Exceeding One(1)Acre Immediately (1) ,, .,. Z C
=
.-
Surrounding Residential Improvement
Other Land (2) - , . C
,• - • . '.-.
4mili C
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete.
Verifyin lion-Signature of Auditor
Date Signed(date,month,year)
-6
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 ssessed value of the mobile home or manufactured home.
Signature of Auditor
of 2 Date Signed(n4;th,day,year)
---/Y1A-eii.d_ 4 it)aat,iins -4.0- 2,0.:25
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-.Taxpayer ..?