Homestead_Neber (2) Resetforin
r a/ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
i;.-1; STANDARD!SUPPLEMENTAL DEDUCTION FORM
apaceState Form5473(R20/12-24)
'•" Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for tiling 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 .
1
I(We) q n tit L. . C iper certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the foliowino described real prope 'under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the 06)
date this application Is signed, - 'date of signature).I(We):
. ❑Am(are)buying under recorded contract.
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
LI 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.
N Buying on Contract,Fee Simple Owners Name
Recordece Where Contract Is Recorded Record Number Page
PROPERTY DESCRIPTION
C9unty Townshl Taxing District(city,town,lawn
shlp)
Ftzt
Parcel Number Legal Description Is
the property in question:
[U°i al/Property ❑Annualy Assessed Motile Home(IC 6-1.1-7)
11 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.
. (Du, - it - C CO .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Stale,County,and Township Is Claimant Vacating a Hom d?
❑Yes
Signature laiman / /
I hereby certify the above statements are true,correct,and complete. �1/L/QonJ�l-
Address of Contact(number and street,city,stale,end ZIP code) Kr of a led Homestead,if any(number and street,city,state,and ZIP code)
- _ e •, �D�• fiza c�c - .
_IJ. Lo-1 IO
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)
Other Improvements (6)
Total Improvements(Line 4 through line 6) (7) it` O 20253
Total Value(Line 3 plus Line 7) (a)
Signature of Assessor Date Signed(date,month,year)
I hereby certify the above Is true,correct,and complete. /-yam
Verifying Action-Signature of Auditor G,BStaApptaO i44dfJ„Sjprlth,,yeYar)
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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 of Auditor .�� Date Signed(month,day,year)
� �� a 0 a Nz
DISTRIBUT' N: Original—County Auditor,File-Stamped Copy—Taxpayer
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