Homestead_Wilkerson (23) Reset Form
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* CLAIM FOR HOMESTEAD PROPERTY TAX [ YEAR
' STANDARD I SUPPLEMENTAL DEDUCTION p
• FORM
� I• �,, S;a1d Form 5473(R2Q 1 12-24i HC1 0
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) r Q11[,/ '4 7 t� " ,j•Oit-J certify that I (we)occupied as my(our)principal place of
residence or am(are)buying the followjpg�described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
7/
date this a ication is signed. l (date of signature). I(We)-
Own. r`, Am(are)buying under recorded contract.
Am (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.
if Buying on Contract.Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Taxing Distnct(city.town, township)
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Parcel Number //D� w 4Legal Description /�7 Is the property in question
241 12CG- 0 ;� - 00 / i 74,5-az.g Real Property Annually Assessed Mob de Home(IC 6-1.1-7)
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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 descrbe the use and portion
of the property utilized to produce income.
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PROPERTY OWNED ELSEWHERE BY CLAIMANT CV
State. County.and Township i ��y� }/� Is Claimant Vacating� a Homestead' �" �' z
L-A d r ti — 1490 ` 6-i-t fic.)d) P ( Yes N� a N
Si azure of lament U
I hereby certify the above statements are True, correct,and complete. �� U
Address of Contact(number and street. city state and ZIP code' of a led Homestead if an '(number and street,city statefrc .' O
i - I ' 47---7&,7 ) ,..,,i cr)
ASSESSOR USE ONLY ASSESSED VALUE i HOMESTEAD VALUE NON-RESIDENTIAL VALUE U
Land Not Exceeding One(1)Acre Immediately (1) 1
Surrounding Residential Improvement
Other Land (2)
Total Land (line f plus line 2) (3)
Residential Improvements or [ -Dwelling (4)
Annually Assessed Mobile i - - ---
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements (Line 4 through Line 6) (7)
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.
Venfying Action-Signature of Auditor 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 mobile home or manufactured home
Signature ' .diter Date S g red r', onth, day an
a...42L �' 01 L as
DISTRIBUTIO : Original-County Auditor File-Stamped Copy -Taxpayer
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