Homestead_Kinsall I Reset Form 1
�4 % CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
(i-iico„�; STANDARD / SUPPLEMENTAL DEDUCTION FORM PO
• ,. State Form 5473(R20 1 12-24) HC10 a 5—
= Prescnbed by the Department of Loca:Government rinar..ce
INSTRUCTIONS See reverse side for fitting instructions
NOTE Telephone, Social Secunty, driver's license, state identification and federal identification numbers are confidential under IC 6-1 1-12-37
CERTIFICATION STATEMENT
I (VVe) 4.� r 1 • 4' Ilink: �% certify that I (we)occupied as my (our)principal place of
residence or am(are) buying the tol wit . seLit -real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
t this application is signed k k !�. �l (date of signature) I (We)
n :._;Am (are)buying under recorded contract
E (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
E Have a beneficial interest in the trust or the nght to occupy the property under the terms of a qualified personal residence trust
Arn (are)the shareholder partner. or member of the entity that owns the property
If Buying on Contract Fee Simple Owners Name
Recorders Office Where Contract is Recorded l Record Number Page
PROPERTY DESCRIPTION
County ^ Township Taxing District Ic,ry ti,t � �' ..
* 1
aU V\
Parcel Number Legal Description s th roperty in question
Real Property E Annually Assessed Mobie Home(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surr nd that structure is used to produce income,describe the use and portion
of the property utilized to produce income
irD...ci ,......
1 ....._ \ , (2,,,, ,..-A ---- 0 0....... _____(s,.. ci-/ ,
0 ZS'-
1 PROPERTY OWNED ELSEWHERE BY CLAIMANT
Slate. County.and Township Is Claimant Vacatr omestead'
Yes r No
+gnature of Claimant
I hereby certify the above statements are true,correct, and complete r // ,
• -----TF".""—
Address of Contact umber and street city, state and Z1• ode) Address of Vacated Homestead if any (number and street, city.state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE 1 NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) Pitt 1)
Total Land (line 1 plus line 2)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile i ---
Manufactured Home I Garage (5) tfr
Other Improvements (6) 1 _k2P5
Total Improvements (Line 4 through Line 6) (7) ,
Total Value(Line 3 plus Line 7) (8) G 0.1r(?-e-e"Ai
Signature of Assessor CQ�� Date Signed(date,month,year)
I hereby certify the above is true, correct, and complete. A//,,
Verifying Action-Signature of Auditor
—1 repti• igned (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 1-1210 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 Au r�cdc2 Date SiTed( onth da year)--y� ^_________
DISTRIBUTION: Original-County Auditor File-Stamped Copy - axpayer
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