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CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
FORM .
% .,... State Form 5473(R20/12-24) HC10 CZ.c.
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for Ring instructions.
NOTE:Telephone,Social Security,driver's license,state Identification and federal identification nuMbers are confidential under IC 6-1.1-12-37.
I
CERTIFICATION STATEMENT •
I(We) I I fr'' irLartig . certify that I(we)occupied as my(our)principal place of •
residence or am(are)buying the followiI describedrealprspAy under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application Is signed, COP i at')7d—it (date of signature).I(We):
j)(Own. 0 Am(are)buying under recorded contract.
D Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
Ei Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
0 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
Coual To ipitfraviazt 1 T. a District( y, township)•wn,toship) 1•••'''''''''''
dliW :47. i I MI : . IREWIT ir.iwiygra Oal
Parcel Number Legal Description Is th property in question:
XReal Property D 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.
6-11-. 9-3e0 - 0,6 el- , ,I? ?#2. o r,3/
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
El Yes
Signat7of Claimant /
I hereby certify the above statements are true,correct,and complete. s, yoto ,
,`21 tlit.av,"?Xi, )4' 01 • iiti -LW q
Addres.of Clltact(nu er;oid street,cityastate,,ZIP code) ., Lit....41 g Addres's of Vacated nO t•-•,if any niU be I.- •s reel,city,state,a ZIP code)
If. 0 )1 ei 6 ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (I)
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)
.„
Other Improvements (6) - '.''''..'AM-
, S
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)
(2.ze.../47..e..e, ,
Signature of Assessor Gies() a ,',ate Signed(date,month,year)
I hereby certify the above Is true,correct,and complete. N COLmin,' 4.46;nco
Verifying Action—Signature of Auditor 'Idantrefyit(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 a man ac re home that is not assessed as real property may not
exceed°renal((1/2)of the ass s valu of e mobile home or manufactured home.
...
Signature o d to DatebeintimatAg...0
DISTRIBUTION: Original—County Auditor,File-Stamped Copy:axpt4ayer 1
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