Homestead_Morrison Riasetf Emir
CLAIM FOR HOMESTEAD PROPERTY TAX
�� •'•~w YEAR
I v. tF,:' 1 STANDARD I SUPPLEMENTAL DEDUCTION _ FORM
(r 2�'"-'—
d;a , State Form 5473(R20/12-24)
'• 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.
`mow CERTIFICATION STATEMENT •
I(We) Or..- ' t!r" + certify that I(we)occupied as my(our)principal place of
residence or. (are)buy g the follniu 2, lfir(�a rty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
his application Is signed, •/�AOt (date of signature).I(We):
wn. C.Am re)buying under recorded contract.
m(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.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION
If Buying on Contract,Fee Simple Owners Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County . Township C) . Taxing District(city,town,township)/ -^
Parcel Number Legal Description s property In question:
Real Property ❑Annually Assessed Mobile Hone(IC6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately s oun that structure Is used to produce Income,describe the use and portion
of the property utilized to produce income.
2C— — 1G — ioo — DO
0C H old
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati a mestead9
❑Yes No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete. /' ea/
tress of Contact(number and street,city,state,and IIP de) �•1•dd e s�J •:rated Homesteadd,if any(number and street,city,state,and ZIP code)
tL•» • Cn Vic 'LA61- `') \ 6
ASSESSOR USE CNLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement '
Other Land (2) .
Total Land(line I plus line 2) (3)
• ,
Residential Improvements or Dwelling (4)
Annually Assessed Mobile
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (6) (� 2.025
Signature of Assessor ,ut,,, V Date Signed(date,month,year)
I hereby certify the above Is true,correct,and complete.
Verifying Action-Signature of Auditor / Date ned(date,month,year)
STANDARD DEDUCTION ALLOWAIIC/
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/C 6-1.1-12 to a mobile home that $
is not assessed as real property or fo a manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of thgfi a or manufactured home.
Signature of Auditor) Date Signe ont, y,year
DISTRIBUTION: Original-County Auditor,File-Slam py-Taxpayer s
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