Homestead_Cox (5) I Reset Form
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'qt CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
ij �+ t STANDARD I SUPPLEMENTAL DEDUCTION FORM
`.R r State Form 5473(R201 12-24) HC10 l ao
Prescribed by the Department of Local Government Finance
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) Sews.0 t-N • • • 8 - ._ - certify that I (we)occupied as my(our)pnnopal place of
residence or am(are)buying the following descnbed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed Ili,'11 M.S. (date of signature) I (We)
.�jy0wn 7 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 right to occupy the property under the terms of a qualified personal residence trust
J Am(are)the shareholder partner, or member of the entity that owns the property
CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County t� Township CO� Taxi District(cdy.town.township) � 0,, i--4-----
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Parcel Number Legal Description ti�_Js the property/� in question
Real Property L I Annually Assessed Moble 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 ` ,
a....c) a., I L't --- k -- - aot , °Do . a ..... 0,2,--1 ,
.........
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claim Placating a Homestead,
Yes ❑ No QQ
Signature of Claimant )
I hereby cer • e above statements are true, correct, and complete
nt (number and street city state, and ZIP code) Address Vaca •• Horn- lead if any (number and street,city. stale, and ZIP code) C3
A. ess of Contact( u y
:3 ( N . 1 QTi n A . • -k— i i . 0C-
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE I
Land Not Exceeding One(1)Acre Immediately (1) O
Surrounding Residential Improvement __ _ r1
Other Land (2) —--
i
Total Land (line 1 plus line 2) (3) ` '
Residential Improvements or Dwelling (4) l Pitikl w
Annually Assessed Mobile! t
Manufactured Home Garage (5)
1::;) )
Other Improvements (6)
Total Improvements (Line 4 through Line 6) (7) v
i /
Total Value (Line 3 plus Line 7) (B) �5
—11
, • A
Signature of Assessor Date Signed(date 42 e.
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I hereby certify the above is true, correct, and complete. Gies
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Verifying Action-Signature of Auditor rY �'" • '-' .'.-le e• Wale month year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or S48 DOC
_----` $
N. standing any other provision the sum of the ions provided in IC 6-1 1-12 to a mobile home that
is not assessed as real property or to a manufactured horn t is no!assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home manufactured home
41
Signatur- ',Auditor / Date Si ned(month day.year)
•
:. s ION: Onginal-County Auditor File-Slam d Copy -T yer
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