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4 re41 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR t
STANDARD ( SUPPLEMENTAL DEDUCTION FORM
�� t, State Form 5473 ji�'Q! i2-24i HC10 /�i2J
-'•'•. 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) 1 r
- b certify that I (we)occupied as my(our)principal place of
residence or a 4 (. e)buyi . thgtpl CJ� ��descti �b�r� roperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
a his application is s-.•-d, (date of signature). I(We)
Own Am(are)buying under recorded contract.
(are;entitled to occupy as a tenant-stockholder of a cooperative housing corporation
E 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.
If Buying on Contract.Fee Simple Owners Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taxing District(city, town, 1,shitp.)
CS\
,3L- (1::::)2-1 J. .
Parcel Number Legal Descnption I the property in question.
eal Property Annually Assessed Mobile Home(IC 6-1.1-7)
tf any portion of the residential structure or the land riot exceeding one(1)acre that immediately surrou hal structure is used to produce income,describe the use and portion
of the property utilized to produce income.
24 ...._
\--L.,_07 407... ._ (2 _ 0 (e____s7
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State. County.and Township
Is Claimant Vacati Homestead?
_ Yes No
Signature of Claimant
I hereby certify the above statements are true, correct, and complete.
Aliiiii
Address oaf Contact{numbr and street.
(city. state rid ZIP code) Address of V cat H es:e any (number and street,city. state, and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE ! HOMESTEAD VALUE 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 F Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements (Line 4 through Line 6) (7)
__ Sf P 08 2025 Total Value (Line 3 plus Line 7) (g)
Signature of Assessor Date Signed(date. month year)
I hereby certify the above is true, correct, and complete.
Verifying Action-Signature of Auditor �te S gned(date,month, year)
B1 •
L11 ±
. • e
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 601't of the assessed value of the homestead or S48,000
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 NI• a toble home or manufactured home
Signature or A,rditar
g (1,•nl �i� iJa gn d(irf�ori �da�earl e.--
DISTRIBUTION. Cngrnai-County Auditor.File-S . ._- opy-Taxpayer
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