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e CLAIM FOR HOMESTEAD PROPERTY TAX
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STANDARD I SUPPLEMENTAL DEDUCTION FORM YEAR
�: State Form 5473(R20/ 12-24) HC10
Prescribed by the Depa-tment 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) ,‘ • • ` a C certify that I (we)occupied as my(our)principal place of
residence or a (.re) •u iiig toe f. .wi , c d re prQQ • under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
ate this application is signed, * t/ (date of signature). I (We)'
Own. ■ Am'(are)buying under recorded contract.
E (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation_
E Have a beneficial interest in the trust or the nght to occupy the property under the terms of a qualified personal residence trust
E 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,town, to ip) ,
(12I) '
Parcel Nu
m Legal Description the ••roperty in question.
At Real Property Li Anxnualty Assessed Mobie Horne(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately su 'on.: that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
1L\ — ) CL\ CoO . L\ Qo6
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is •i Vacating a Homestead/
— es No
Signature of Claimant
I hereby certify the above statements are true, correct, and complete. Litije '
lite
Address of Contact(number and street, city. state and ZIP code) Aedress of acated Home read y(► ran. s reef, el. 'fie, and ZIP cod:)
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ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE 1 �
Land Not Exceeding One(1)Acre Immediately (1) `1
Surrounding Residential Improvement
Other Land (2)
Total Land (line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile 1
Manufactured Home Garage (5) El-W)-
Other Improvements (6)
Total Improvements (Line 4 through Line 6) (7) S EP ' 2025
Total Value (Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date,month. year)
I hereby certify the above is true, correct, and complete. rr
Verifying Action-Signature of Auditor , ''" / r J, 4 Date signed(date,month. year)
r,18SON "CUNT nt IDITOR
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60°'0 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 S
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 manufactured home
Signature o'A di or � � T Date gne c month.Oa ear)
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DISTRIBUTION: Onginal-County Auditor File-Stamped Copy - axpayer i
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