Homestead_Stewart (3) iteiiiftariii—!
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. 't CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
101): STANDARD/SUPPLEMENTAL DEDUCTION FORM
HC10
Pligin
•,,, ,..,. State Form 5473(R20/12-24)
lea Prescribed by the Department at 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) 'wiliP t::.& sw-orip. certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the felT1 li9jib2 rdterry under contract for which a Homestead Property Tax Standard Deduction Is hereby claimed on the
te I application is signed, (date of signature).I(We):
. 0 (are)buying under recorded contract.
0 (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
El Have a beneficial interest in the bust or the right to occupy the property under the terms of a qualified personal residence trust.
0 Am(are)the shareholder,partner,or member of the entity that owns the property.
CONTRACT RECORDED
It Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract Is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township ),„..)...0 Taxing DistricL(c/ty,Ipwrr,township)
C:)-S \ y•TOU...)r\Parcel Num r Legal Description Is the property in question:
0 Real Property 0 Annually Assessed Made Home(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.
21.. ' 0 k -s 2- ----• k00,___COO , L\\
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is i :nt Vacating a Homestead?
K.Yes 0 No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete. C.i6'. ,ir
Address of Contact( roar are;t, ' , and ZIP code) Address of Vacated Homestead if any, (number ends treet,city,s le,a P code),
2: 3 s .
Illi
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately Surrounding Residential Improvement (1) .' , ". '","-".. .
,- --,-;.....;;.' ': ',. •,'"• '.-- "Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) Pit t,.,, •,. .- :
. . .„
. . . .,
Annually Assessed Mobile/
Manufactured Home Garage (5)
Other Improvements (6)
, -
Total Improvements(Line 4 through Line 6) (7) ' 44 1
1 4 ,
Total Value(Line 3 plus Line 7) (0) ...025
Signature of Assess Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete. 0/13s
Verifying Action-Signature of Auditor Date Signed(date,month,year)
1 Y A
"I a I
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 n• assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home: .•: ured home.
Signature of Audi Date Signed( oAth,da year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpaye
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