Homestead_Brogan 'Reset Form
CLAIM FOR HOMESTEAD PROPERTY TAX
• ' (;:tk.,ezi
STANDARD / SUPPLEMENTAL DEDUCTION
FORM YEAR
. r•! State Form 5473(R20/ 12-24) HC10
Prescribed by the Department of Loca:Government Finance
INSTRUCTIONS See reverse side for filing instructions
NOTE Telephone Social Security drivers license state identification and federal identification numbers are confidential under IC 6-1 1-12-37
CERTIFICATION STATEMENT
I (We) aila f — gilk_ 4* e 0 l& certify that I (we)occupied as my (our)principal place of
residence or am(are)buying the following descnbed real property under contra- • which a Homestead Property Tax Standard Deduction is hereby claimed on the
date t application is signed % %a. 140-. (date of signature) I (We)
Own II Am(are) buying under recorded contract
D Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
II Have a beneficial interest in the trust or the nght to occupy the properly under the terms of a qualified personal residence trust
Ain (are)the shareholder partner or member of the entity that owns the properly
If Buying on Contract Fee Simple Owners Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Coun Township Taxing District(city.town,township)
Parcel Number Legal Description is the property in question
Loot al Property L 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
D 2 _ ` ... l r c u , cco . O -( OC
-
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County and Township Is Claimant Vacatin�g/a Homestead?
_ Yes I]G No
Signatu of Claimant ✓` /
I hereby certify the above statements are true, correct, and complete I +...". •
A a . II 1 .% A • /A l - �A.A to Address of Contact(number and street city, state and ZIP code) Address of Vacated Homes ead. if .t umber and street city state and ZIP ) ���/)-
•
r — El .
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement _ —_ _
111
Other Land (2) -1F .11:EI:11
Total Land (line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) •
Annually Assessed Mobile I 15
Manufactured Home Garage (5)
04111:5 —d7
Other Improvements - (6)
Total Improvements (Line 4 through Line 6) (7) f�� �"'"
Total Value(Line 3 plus Line 7) (8) W ,ylr u rI'�IpR
Signature of Assessor ihibilifOLOWArqntti.year)
I hereby certify the above is true, correct, and complete. GI$
Venfying Action—Signature of Auditor Date Signed(date. month year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60''/G of the assessed value of the homestead or 546 000
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 of Auditor Dale Signed(month, QeX,year
. m 1`-.11rVlr .
Odt-�.Q \LO...4-.0L.;+—Z I
DISTRIBUTI : Original—County Auditor File-Stamped Copy —Taxpayer
Page 1 of 3