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Homestead_Comer t` 7 f ' ' Afisetform ' �. '� CLAIM FOR HOMESTEAD PROPERTY TAX s,. y,4 YEAR x� ).. 1l,y STANDARD/SUPPLEMENTAL DEDUCTION FORM n; ,xc. State Form 5473(R20112-24) HCI0 rMe la 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 r- I(We) 1�• r', C • -V , certify that I(we)occupied as my(our)principal place of residence or am(are)buy g the f9I1 fig cri rea roperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the a this application Is signed, a l�� (date of signature).I(We): Own. Ann(are)buying under recorded contract. ❑ (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. I ❑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. 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(cityaown,to ship) ,.Sow O 2- Vn e..--- Parcel Numb Legal Description I I th roperty in question: Real Property 0 Annually Assessed Mobile Home tic6-1.1-7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately sur n that structure Is used to produce income,describe the use and portion of the property utilized to produce Income. 26 - \"4- - 0t. -t&0k.k - 0 00. 0\1-- 022- . PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is Claimant Vacatinga mestead? 0 Yes No Sign re of Claim. t I hereby certify the above statements are true,correct,and complete. Address of Contact(number and street,city,state,end ZIP code) -Addre of Vacated Hornestea."any(number and street, ty,state,and ZIP co e) 101" w S\10k ;r* N.v,k r-N1--Ll---b 6 --°' - ASSESSOR USE ONLY 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) T T Residential Improvements or Dwelling (4) IL Annually Assessed Mobile/ D,-- , Manufactured Home Garage (5) Other Improvements (6) ;y/.„`,,. ` :'`! : ` '' Total Improvements(Line 4 through Line 6) (7) JUN' 1 1 '`025 Total Value(Line 3 plus Line 7) (8) Signature of Assessor Aerjoeutze a ateate S ,month, ar) I hereby certify the above Is true,correct,and complete. GIB.r1N CO Verifying Action-Signature of Auditor �krate,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 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 oMu.A..) itorr _ '�� Date d( nth,^ n day.year) +) DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 3