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C'" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION FORMYEAR
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 end federal identification numbers are confidential under IC 6-1,1-12.37,
CERTIFICATION STATEMENT '
I(We) piex ys\ s certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the folio g descAedrat property un tract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, —% �.„(date of signature).I(We):
(I�R1wn. 0 Am(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.
0 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
Coin \D.0 Township Taxing Districtcity,for -M hip •
Parcel Number Legal Description ' Is the pro rty in question:
Property 0 Annually Assessed Mobile 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.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Hom stead?
0 Yes o
Signature•igil ant
I hereby certify the above statements are true,correct,and complete.
Address of Contact number a� •street,city,state,and ZIP code) Address of Vacated Homestead,if a (number and sirx
,state,and ZIP code)
/ r
ASSESSOR USE ONLY ASSESSED VALUE ' 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) - Ft ED
i
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) AUG
Other Improvements (6) - �'1 U /8 2n„.
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8) �i jE3sON(r� col
Signature of Assessor Me"-•.I=• :ari' year)
I hereby certify the above Is true,correct,and complete. AU
Verifying Action—Signature of Auditor . Date Signed(date,month,
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or S48,000.
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 to a manufactured home that is not assessed as real property may not
exceed one-half(1/2),df the assessed value dine mobile home or manufactured home.
Signet a of Auditor,. .\e-> \ . Date SigneQ[montthlday,year
a_a a \} t1f Cam Q- �-
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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