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• CLAIM FOR HOMESTEAD PROPERTY TAX _ YEAR
STANDARD / SUPPLEMENTAL DEDUCTION FORM
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t. / State Form 5473(R20/12-24) i
`—% Prescnbed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions
NOTE Telephone, Social Secunty, dnver's license, state identification and federal Identification numbers are confidential under IC 6-1 1-12-37
1 , CERTIFICATION STATEMENT
I (We) , [gyp V A [ certify that I (we)occupied as my (our)pnncipal place of
residence or am(are) buying the folio g c lea under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
at this application is signed Il ro (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
Have a beneficial interest in the trust or the nght 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
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County -)1CP Township Taxing District(city •wn,//��town hip)
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Parcel Number Legal Description Is a roperty in question
eat Property C Annually Assessed Mobae Home(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one (1)acre that immediately surro ds at structure is used to produce income describe the use and portion
of the property utilized to produce income
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State. County and Township Is Claimant Vacating Homestead
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Signature of im ‘
I hereby certify the above statements are true, correct, and complete.
• Address of C act(number and street cd state and ZIP cod ) e+l •• ••dress of Vacate mestead.if any (number and street city stale and ZIP code)
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ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
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Total Land (line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile + - --,--
Manufactured Home Garage — (5) D
76
Other Improvements (6) C>
Total Improvements (Line 4 through Line 6) (7) 04%
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Total Value(Line 3 plus Line 7) (8) ��'! `(ei%
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Signature of Assessor J GCP Date Signed (date month, year)
I hereby certify the above is true, correct, and complete.
Verifying Action-Signature of Auditor Date Signed (date month year)
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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 properly may not
exceed one-half(1/2)of the assessed value of the mo ome or manufactured home
Signature of Auditor I Date Signed(month. day year)
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DISTRIBUTION: Original-County Auditor File-Stamped Co payer
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