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4 CLAIM FOR HOMESTEAD PROPERTY TAX
14 ' STANDARD I SUPPLEMENTAL DEDUCTION FORM YEAR
State Form 5473(R20/ 12-24) HC10 Z)
•• iPrescribed bythe De alment of Local Government Finance '
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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) 4 a Ok.A G\ • . ' e_l certify that I (we)occupied as my(our)principal place of
residence or am(are) • yin follo}rw1 `rj)fd at p�perty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed. l L � (date of signature). I (We)
Awn ._ Am (a-re)buying under recorded contract.
(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
C 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.
CONTRACT RECORDED
If Buying on Contract Fee Simple Owners Name
Recorder's Office Where Contract is Recorded Record Number `Page
PROPERTY DESCRIPTION
County Township ^_ Taxing Osstnct(city. town, townsht.
-S AC) ‘(,)
. 00 . \elc,,D
Parcel Number Legal Description Is' e property in question
Real Property Arvwafy Assessed Mobile Home(IC 6-t.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately shun that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
2-. 6 - i ___ '-- 0 - \ 0
I 0 0 o
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State, County,and Township Is Claimant Vacati mesteadl
_ Yes o
Si mature—of Claimant
I hereby certify the above statements are true, correct,and complete. s�L!� 04
d•ess Contact(number and street. city state. and ZIP code' Address of Vacated Homestead if any(number an str ' ity state and ZIP code/
+ ' _ -16-1 (-6
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre immediately (1)
Surrounding Residential Improvement
Other Land (2) PIL 1
Total Land (line 1 plus line 2) j (3)
-4611)
Residential Improvements or Y Dwelling (4)
Annually Assessed Mobile ;
Manufactured Home Garage (5) Sep
Other Improvements (6) <2
Total Improvements (Line 4 through Line 6) (7) rii
•
• 0 �j
Total Value(Line 3 plus Line 7) _(8) i ti Cn
Signature of Assessor �4/4,� Date Signed(date, month. year)
I hereby certify the above is true, correct, and complete. A/'vO - `.
Verifying Action-Signature of Auditor �«T:-,e Signed(date. month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser or 60%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 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 home or manufactured home
5 natty e'Audi!ar \ Date S -ion/
sert-
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DISTRIBUTION: Onginal-County Auditor File-Stain opy-Taxpayer
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