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• i�a.,,4�, CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
J. '; STANDARD / SUPPLEMENTAL DEDUCTION OR
\+., f:, State Form 5473(R20 1 12-24) C)_
Prescribed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions
NOTE Telephone Social Security dnver s license. state identification and federal identification numbers are confidential under IC 6-1 1-12-37
CERTIFICATION, STATEMENT
I (We) a e. A. ' � /
� a certify that I (we)occupied as my (our) principal place of
residence or am(are)buying the follow g scribed real roperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date thi pplicatton is signed � )_ VB — S idate of signature) I (We)
Am(are)buying under recorded contract
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
Ii Have a beneficial interest in the trust or the right 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
County Township Taxing Di 1(city,town,towrz.s.hip)
C.,..... .% ‘19S3 n • A.„(r-1 k Of\ CY--
Parcel Number Legal Description Is the property in question
eat Property Li Annually Assessed Motile 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
alp-- et ~cO — 100 tea . Lk(Xi — Q ii,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County and Township Is Claimant Vacating a Homesteads, kr/
KY es I] No YSigna o►Ct antj."..e..,( '` 'y ,Ai
I hereby certify the above statements are true, correct, and complete /Y- 'V'�
Address of Contact(number and street city state and ZIP code) Address acated Homestead if aX
and street city stare and ZIP co•e)
ASSESSOR USE ONLY ' ASSESSED VALUE HOMESTEAD /ALUE VON•RFSIDENTIAL VALUE •
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement _ 41
Other Land (2)
Total Land (line 1 plus line 2) (3) oi' 13 '" ,
J ?0245
Residential Improvements or Dwelling (4) V
Annually Assessed Mobile I - rri§e5,—) ••• Z4i5)
Manufactured Home Garage (5) G/Q.�,^V� ��
Other Improvements (6) '" Ct7 �`
Total Improvements (Line 4 through Line 6) (7) 'q�J0`T • 0
Total Value (Line 3 plus Line 7) (8) Oyi, d
Signature of Assessor Date Signed(date. month year) o
I hereby certify the above is true, correct, and complete.
II
Venfying Action -Signature of Auditor Date Signed (date month year)
• i1
STANDARD DEDUCTION ALLOWANCE �-.
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 548 000 1
Notwithstanding any other provision the sum of the deductions provided in IC 6-1 1-12 to a mobile home that 5 N
is not assessed as real property or to a manufactured home that is not assessed as real property may not n
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home
Signature of Auditor ` Dale Signed (month day, year)
tli( .tJr0i...i.Q 'i ce 11.E r If\ — 1 —. .
DISTRIBUTION: Original-County Auditor. File-Stamped Copy -Taxpayer
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