Homestead_Wagner (6) 'Reset Form ;
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�a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
ii �� STANDARD / SUPPLEMENTAL DEDUCTION r FORM 340, 2
.1. . State Form 5473(R20/ 12-24) HC10
"- " Prescnbed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions
NOTE Telephone Social Secunty, dnvers license, state identification and federal ruent trcatron numbers due ;;unfidential under IC 6-1 1-12-37
CERTIFICATION STATEMENT
I (We III V N IIt jI Ii f _- certify that I (we)occupied as my(our)pnnapal place of
residence or am (are) bu ing the fflll�r rlfl d Ab.:• .'al puberty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
his application is signed 1"L Q� (date of signature) I (We)
Own
dat11 Am(are)buying under recorded contract
(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
❑ 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 District Icily.t n,tocY;:y:iJ,
�n 02`+- • • 1ws .
Parcel Number Legal Description t e property in question
Real Property D Annualy 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 sun nd that structure is used to produce income descnbe the use and portion
of the property utilized to produce income
2 ) 1 , 090 3 ,s---- _ 0 ,2:i_
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County and Township Is Cl. ant Vacating a Homestead,
' es ❑ No
Sr cite of laimant
I hereby certify the above statements are true, correct, and complete b -
Ad• ess of Contact(number and street city state and ZIP code) \ Address of Vacated Homest if any mum and st sty state a code)
10C 0 aka fL8. -- ? 1, 01-, -Thn r S -V S c1V.‘
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
-----FilLi
- — -
Total Land (line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I - - f}�']1
Manufactured Home Garage (5) DEC
2025
Other Improvements (6)
Total Improvements (Line 4 through Line 6) (7)
Total Value (Line 3 plus Line 7) (8) Gee �N CO `�'�'
Signature of Assessor UN 1 fi glTv ue month.year)
I hereby certify the above is true, correct. and complete. �r I OR
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 $
is not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed one-hall(1/2)of the assessed value of th home or manufactured home
Signature o1 At dito - Datp 72 (month day. year)
r\-\ IC,
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DISTRIBUTION: Original-County Auditor. File-Stamped-Copy-Taxpayer
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