Homestead_Aslinger Reset Form'
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,a a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
• A. i; STANDARD ! SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R20 1 12-24) HC10
`` -_1. 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) • MI(\ca. e_ 1 q t-Ns I f i ( . — _certify that I (we)occupied as my (our) principal place of
residence or am(are)buying the following d cribed re I property under coot ct r which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed I "'d (date of signature) I (We)
.KOwn -) 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 nght 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
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
C my Township Taxing District lc:;y town. township)
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Parcel Number Legal Descnption ' Is the property in question
eat Property i-: Annually 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 surrounds that structure is used to produce income describe the use and portion
of the property utilized to produce income
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is Claimant Va ting a Homestead,
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Signatu 9,1 Cla loci I yaw r
I hereby certify the above statements are true, correct, and complete �/
llAddress of Contact(number and s et city state and ZIP code) Address of Vacated Homeste.d.if any(number an stree. city •tate and ZIP Cot
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•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)
Total Land (line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile t
Manufactured Home Garage (5)
Other Improvements (6) 1%15ANN
Total Improvements (Line 4 through Line 6) (7) C O j
Total Value(Line 3 plus Line 7) (8) • 4
Signature of Assessor Date Sigryed 7 Ili/ th[ G.-
I hereby certify the above is true, correct, and complete. / P� `�,
Verifying Action-Signature of Auditor L ed (date month year)
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STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or S48 000
Notwithstanding any other prevision 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 value of the mobile home or manufactured home
Signature of Auditor Date Signed(month. day, year)
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OISTRIBUTI N: Original-County Auditor, File-Stamped Copy -Taxpayer
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