Homestead_Fithian (5) • v Reset Form
71'4R4'' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
ç' 4:4! ; STANDARD / SUPPLEMENTAL DEDUCTION
b FORM
State Form 5473(R20/12-24) HC10alat1- 1'
=_! Prescribed 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
CERTIFICATION STATEMENT
I (We) rtN er\Z 1 C a. I i a n certify that I (we)occupied as my(our) prinapal place of
residence or am(are) buying the following descnberd realproperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this plication is signed. , 11 i ° 1 (dale of signature) I (We)
wn 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
CONTRACT RECORDED
If Buying on Contract, Fee Simple Owners Name
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Coun Township Taxi g District(city, town, township)
(-- 1 bin \A(N\ QiN . U-N; c - 0a> .
Parcel Number Legal Description Is the property in question
tolk$al Property fi 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,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?
Yes No
Signatur of Cn nt s,
-------61
I hereby certify the above statements are true, correct, and complete.
'Address of Contact (n tuber and street city state, and ZIP code) A..ress of Vacated Hom cad if any number and street, city, state 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) FILE])
Total Land (line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I -
Manufactured Home Garage (5) NO
_
Other Improvements (6)
Total Improvements (Line 4 through Line 6) (7)
o
F Total Value(Line 3 plus Line 7) (8) GIESoA q. irtl -k •
Signature of Assessor Da
gritfigiried
I hereby certify the above is true, correct, and complete. ►M Atfpl
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Verifying 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 548 000
Notwithstanding any other provision the sum of the deductions provided in IC 6-1 1-12 to a mobile home that $ I
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 Date Signed(month day,year
ini— PJI"Na-,&1•1) CI- -'\ )°C0--
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DISTRIBUTION: Onginal-County Auditor File-Stamped Copy - Taxpayer
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