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,dij .L CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD / SUPPLEMENTAL DEDUCTION FORM YE R
• r�. -_ '.-- ' State Form 5473(R20I 12-24)
HC10
•
Prescnbed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for fling 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
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I (We) certify�'"I .� 7� , 4-- / certify that I (we)occupied as my(our)pnnapal place of
residence or am (are)buying the foil. ing descnbed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed (date of signature) I (We)
XOwn 11 Am(are) buying under recorded contract
D 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
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 j
Record Number Page
PROPERTY DESCRIPTION
Con . ) 7q
Tam) yto ( /, L
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Parcel Number Legal Description is the property in question _)
Real Property ❑ Annually Assessed Maxie Home{IC tit 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
1..71 Ce-7—. i 17.--- C ql--- 1-71) .--'' 06 tf-, 3 / I -- 6 .2__/
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State Coutty rid owns ip / ` _ teo Is Claimant Vacating.a Homestead?
/ AI 1/� �/ //G/L{/n _ Yes
I hereby certify the above statements are true, correct, and complete /7�2�1�.A.�,�15 q-,
Address of Contact nu and street. city stale, a d 21 j Address of Vaca eHomestead, if a (number er`^ d street city state. and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) FitED
Total Land (line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I - — - -
Manufactured Home Garage (5) E
Other Improvements - (6) 20}��ji
-
.G -
Total Improvements (Line 4 through Line 6) (7)
Total Value (Line 3 plus Line 7) (8) a'fBs
Signature of Assessor COI 1 • !A! •
ed(date month year)
I hereby certify the above is true, correct, and complete. I v i , •
AlUQlT •
Verifying Action-Signature of Auditor Date SigQi?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-half(1/2)of the assessed he mo le home or manufactured home
Signature f ddor Date Signed( oe/hd ar ��
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DISTRIBUTION: Onginal-County Auditor File•Stamped Copy-Taxpayer
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