Homestead_Whitler Reset Form
• ,a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
ctoo„� STANDARD / SUPPLEMENTAL DEDUCTION FORM
4! State Form 5473(R20 1 12-24) HC10
=_'iii_. Prescribed by the Department of Local Government Finance
INSTRUCTIONS. See reverse side for filing instructions
NOTE: Telephone, Social Secunty, driver's license, state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I (We) % '4/\.SOICA titO - ' certify that I (we)occupied as my(our)prinapal place of
residence or am(are)buying the filon F n 2je I Blperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
da this application is signed L� (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 right to occupy the property under the terms of a qualified personal residence trust.
I Am(are)the shareholder, partner, or member of the entity that owns the property
CONTRACT RECORDED
If Buying on Contract, Fee Simple Owners Name
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township xi? Taxing District(city. town,township)
k.
. 3°A U431.\\ \e-<___A/ _
Parcel Number , Legal Description Is the property in question
9 P
17
Real Property ❑ Annually Assessed Mobile Home(IC 6-1.1-7)
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 descnbe the use and portion
of the property utilized to produce income
..._2.___6
01 (1 _ 0)ic .
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cco \ 5,..1
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County.and Township Is Claimant Vacating a Homestead"'
Yes ❑ No
Signatu of Claimant
I hereby certify the above statements are true,correct, and complete. 4
�t-
Address of Contact(number and street city. state and ZIP co.- Address o ated Homestead. f any(number and stree,•city, state and ZIP code)
ASSESSOR USE ONLY p NSSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land (line 1 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.
Verifying Action-Signature of Aud tr.„,r Date Signed idate month year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 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 $
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 valu e mobile home or manufactured home
SignatureditoraDate Signed ( d\41 ark ? )
,‘D Y\-S
1
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DISTRIBUTION: Original-County Auditor.File-Stamped Copy -Taxpayer
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