Homestead_Stone (6) Reset Form
�" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION FORM YEAR
1/ State Form 5473(R20 I 12-24) HC10 n
�'�" Prescribed by the Department of Local Government Finance w� `
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) T b .e.--6Q-i 4- W 1 *- SA-cone_ certify that I (we)occupied as my (our)principal place of
residence or am(are) buying the followin descried real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed /Q (g 30 ZS.. (date of signature) I (We)
Own 11 Am(are)buying under recorded contract
❑ Am (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 Owner's Name
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Cozen Township Taxi ct(crty. own. township)
*1\047:)() 0 1 C•.)
Parcel Number Legal Description Is the p e n question
Real Properly Annuals/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
(so ..... 1Icco \ . 7LcC& I 1
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County and Township Is Claimant Vacating a Homestead?
Ti Yes ❑ No
' Signature of Claimant
I hereby certify the above statements are true. correct. and complete.
L4-1" - .4W"ia2—
t----e -4 :4;'d-j -1 -
Addr s of Contact(number and st -t cit slat and ZIP cede), • Address f Vacated Homestead.if any (number an sueeF s to and ZIP code)
to
II / I di • Li3 . '4. I ilik ! 14?
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE 1 NON-RESIDENTIAL VALUE
.
Land Not Exceeding One (1)Acre Immediately '�
Surrounding Residential Improvement ). 1 r tilt ) ti . T4 1 .
Other Land (2) / rgr
4 1U1 1S ,. = �J
Total Land (line 1 plus line 2) (3) 1 `�1_� _k*--ksik-ka.
,
Residential Improvements or Dwelling (4) Piti, .b
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements (Line 4 through Line 6) (7) 0
Cl �
Total Value(Line 3 plus Line 7) (8) 0
Signature of Assessor • 45 Date Si (date.month, year)
I hereby certify the above is true, correct, and complete. G,�y
Verifying Action -Signature of Auditor QSOA'C Q Date Signed (date month year)
Y vN: -
STANDARD DEDUCTION ALLOWANCE
• a
20 Pay 20 Lesser of 60%of the assessed value of me 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 5
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 of Auditor `,,,.z)„,,ckz - Date Signed(month. day year)
1. ,,,,i,_,& a_ 1 Q - w_c .
DISTRIBUTION: Onginal-County Auditor, File-Stamped Copy -Taxpayer
Page 1 of 3