Homestead_Manion Rasetfdrm;
s; ' e '`fit CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
*,„ _,• State Form 5473(R20/12-24) HC10
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) , K a ( r e I a/\, certify that I(we)occupied as my(our)principal place of •
residence or am(are)buying the f wig• cpbed rea(,l under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
ate is application is signed, 1 ��I '(date of signature).I(We):
Own. ❑ (are)buying under recorded contract.
(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 bust.
❑Am(are)the shareholder,partner,or member of the entity that owns the property.
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(city,t
30
Parcel Number • Legal Description s th ppdtty in question:
VVVVVV 1 Reairo Property 0 Annually Assessed Mobile Horn(IC 6-t.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately sun n that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
2� r \\„, �`Z-2�3-- Ono. 5co28
.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati g omestead7
❑Yes
alur,• Claimant
1 hereby certify the above statements are true,correct,and complete. 4al' ts
tk
Address of Contact fnumbei22 nand street,ciTtalocIZIP code) - 1 •
dress of V rat omestead,if any(number end st r,city,state,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement Other LandILETotal Land(linei plus line 2) I(3)
Residential Improvements or Dwelling (4) -
Annually Assessed Mobile/
Manufactured Home Garage (SiUL I 1 2025
Other Improvements (6) •
Total Improvements(Line 4 through Line 6) (7) •
/ a
Total Value(Line 3 plus Line 7) OIS`4)S C uisiiTy a ^"�y""�,
Signature of Assfis.to(uVial r C11 Date Signed(date,month,year)
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%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 ho 's not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mo a manufactured home.
Signature of itor A Date Signed(mo 111y,ygad 25
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer •
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