Homestead_Stigall _ Reset Form
a- . • CLAIM FOR HOMESTEAD PROPERTY TAX
'1; ''. ,' STANDARD ! SUPPLEMENTAL DEDUCTION I FORM YEAR j
. .:! State Form 5473(R20/12-24) 1 HC117
'•••- • Prescribed by the Department of Local Government Frna-c.,.
INSTRUCTIONS:See reverse side for filing instructions ,fir- 1•J I 1 r1 11
NOTE Telephone, • - . •• •river's license, state identification and federal identification numbers o idential and r l . - -3�"
CERTIFICATION STATEMENT
C } Ingli. BL ._ I fib. Irk1 ally that I (we)occupied as my(our)principal place of
residence or am uying the ou t •._ d at) ro• under Contract for whi• a Homestead�operty Tax Standard Deduction is hereby claimed on the
•• • e• _ i/`i. L (date of signature) I(We)• ( `
Own. Li •• (are)buying under recorded contract
L.-- L� • (are)entitled to occupy as a tenant-stock older f a coo_p�e�@lti) t o using corporation
-ve a beneficial interest rn the trust or t is t\o fq t property under the terms of a qualified personal residence trust
Am(are)the shareholder, partner,or member of the ntity that owns the property.
\r\QAC
If Buying on Contract.Fee Simple Owners Name
Recorder's Office Where Contract is Recorded ii Record Number Page
PROPERTY DESCRIPTION
County Township Taxi t G wn, township)
._San • a
Parcel Number Legal Description s t property in question.
Real Properly Annually Assessed Mobile Horne(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one('I)acre that immediately surr n that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
2.,.._ .-- \ 000._ ��
a 1
a
___ 02,y .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County and Township
Is Claimant Vacati g Homesteads
__ Yes No
1 ature of I imam
I hereby certify the above statements are true, correct,and complete.
r and ;
• �dress�Contact(numbersliest.city f ter7 and ZIP code) Address of Vacated Homestead,rf any(number and street. city. state and ZIP codo)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDEN'TWL VALUE
Land Not Exceeding One(1)Acre Immediatelyi___ 41 . _ .
(1)
Surrounding Residential Improvement
Other Land (2) ;_.,f
Total Land (line 1 plus line 2) (3) -Lk) ___,
' Residential Improvements or Dwelling (4)
...b
Annually Assessed Mobile 1 —
Manufactured Home Garage (5) S(p
Other Improvements (6) ' ' / 202 —
Total Improvements (Line 4 through Line 6) (7) (f 5
Total Value(Line 3 plus Line 7) (8) s
-S gnature of Assesacr — / Date S grad!date, month year)
I hereby certify the above is true, correct, and complete. Th'.4,
Verifying Action-Signature of Auditor Up/�QR Date Signed(date,month.year)
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 not assessed as real property may not
exceed one-half(1/2)of the assessed value of the •• •me or manufactured home
Signature .•Auditor l
base S e nul d year) .
ilL
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2_ )
I 1, — CA ‘
DISTRIBUTION: Original-County Auditor File-Stampe •• axpayer
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