Homestead_White (7) r` , iliiii Ft>i 171:
• d"''44 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
. State Form 5473(R20/12-24) HC111 ar
`�* 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) „ it) 'IrT1 certify that I(we)occupied as my(our)principal place of
residence or am(are)buying I e fo in Ilse r l gigpOivonder contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
�datte this application is signed, (/ ate of signature).I(We):
IlSOwn. 0 Am(are)buying under recorded contract.
/0 Ant(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.
❑Ant(are)the shareholder,partner,or member of the entity that owns the property.
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Coun • Town p Taxing Dist w
jJs t riNarlJAi8l7 ` ir"-- " .", r�V t 1
Parce rriber Legal Description Is-r a property in question:
• �i Real Property 0 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 surrounds that structure Is used to produce income,describe the use and portion
of the property utilized to produce income.
M19 61 — Li7o & —oa I s / —' s(7
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
0 Yes Alo
Si u of Claimant
I hereby certify the above statements are true,correct,and complete.
,,6 Add•-ss otgntac. •umber and street,ci•• state,and Z P ode) "AV '••d e ca ed Homestead,if any(number and street,city,state,and 21P code)
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1) r
Surrounding Residential ImprovementT
Other Land (2) Ei)
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) 75 rrf. . 2,20 1
Other Improvements (6) -r"``
Total Improvements(Line 4 through Line 6) (7) GI8$O C C2
Total Value(Line 3 plus Line 7) (8) N COVAJ1_v 25' ;
Signature of Assessor Date Signed(date, {y &
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 h 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 enufactured home that is not assessed as real property may not
exceed o e-halff((1/2)of the asses d value off mobile home or manufactured home.
t Sigma/furl f udi r ` di—k.tal Date ig� (aitY, d
1f s
DISTRIBUTION: Original Auditor,File-Stamped —Taxpayerf 1�� '
9 b Pe Copy
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