Homestead_Hite 'r:�V•--mot-;�
t it esetYFonn;
'-'� CLAIM FOR HOMESTEAD PROPERTY TAX
YEAR
rf - 3 STANDARD I SUPPLEMENTAL DEDUCTION FORM
y ..�,• Stale Form 5473(R20/12-24) HC1 g !O r'2 y-
�!r Prescribed by the Department of Local Government Finance J
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.
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CERTIFICATION STATEMENT
a
I(We) 1 M✓; certify that I(we)occupied as my(our)principal place of
residence or am(are)�i g the folloio des d re roperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application Is signed, "'. %4 '2. (date of signature).I(We):
❑Own. .•n Arn(are)buying under recorded contract.
❑Am(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. .
CONTRACT RECORDED
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,town,township)
Parcel Number 5 Legal Description s the roperty In on: V '
Real Property ❑Annually Assessed Motile Hone(IC 6-l.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately su n that structure Is used to produce Income,describe the use and portion
of the property utilized to produce Income.
2 \-- -2 \ —moo -poy , E1 - 21 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
• Yes El No
Signature o Claimant
I hereby certify the above statements are true,correct,and complete. ! / ^.i// 9P n „/1"
Address of Contact(number and street,�ty,s^tate,and ZIP code) Addres of Va . •Horned..-d,It any(number and street, statte,and ZIP code)
�?6S—s uJ,11a� t7Wl Ci• oivAle 32 i.1n 0.4r,_Wr AK . k t- 1-1-t 1
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I 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/
Manufactured Home Garage (5)
Other Improvements (6)
jilt
Total Improvements(Line 4 Through Line 6) (7) 14 ��?S
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor �/ Dale Signed(date,month,year)
I hereby certify the above Is true,correct,and complete. BS+ON CO co
Verifying Action-Signature of Auditor U/VT_q s? G. Date Signed(date,month,year)
STAN DARD 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 Si ned onth, ay,year)
MU \1;n--S ll{ 22 5" •
DISTRIBUTION: Original-County Auditor,File-Scam Co axpayer
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