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1. n.,.�, CLAIM FOR HOMESTEAD PROPERTY TAX 1 YEAR
(i' `:
., STANDARD / SUPPLEMENTAL DEDUCTION FORM
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State Form 5473(R20 t 12-24) l
1-4.4- Prescribed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions
NOTE Telephone Social Secunty, driver's license, state identification and federal identification numbers are confidential under
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CERTIFICATION STATEMENTII
I (We) g ALA Iii.• j _ certify that I (we)occupied as my our) . I.-
residence • am (are)buying the toll • 2rea ,'••-rty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date is application is signed. � (date of signature) I (Wel
Own Am re)buying under recorded contract DEC 08 2025
❑ (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 A Township Taxing Dist, ity,town,tow hip)
O
Parcel Number Legal Description is the property in question
eal Property ❑ 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 descnbe the use and portion
of the property utilized to produce income
014 - 40L/ - dg - 3ao - 000. /5 a - aa-o
N
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County. and Township I-Clai. ant Vacating a Homestead? (J
Yes ❑ No 1
Signat f Claimant
SO
1 I hereby certify the above statements are true, correct, and complete.
Anr • ` , Add . of Contact(number and street. ci tare, and ZIP code) Address of Vacated Homestead. if any (num• . street, city. state, and ZIP code)
l l 1\ 1 / ✓�! _ A. 'iJ 3 , c�.� V' ,C Y s off,V` +un-" 1_ . 0
1 ASSESSOR UiE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE 1
SA - w\`'k Land Not Exceeding One(1)Acre Imm=. ately (1) 0
11JN✓ `�v� . Surrounding Residential Improvement O
Other Land (2)
0
Total Land (line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I I
Manufactured Home Garage (5)
0
Other Improvements (6)
Total Improvements (Line 4 through Line 6) (7)
Total Value (Line 3 plus Line 7) (8)
Signature of Assessor Date Signed (dater month,year)
I hereby certify the above is true, correct, and complete.
Verifying Action-Signature of Auditor Dale Signed (date month. year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60% of the assessed value of the homestead or S48 000
Notwithstanding any other provision the sum of the deductions provided in IC 6-1 1-12 to a mobile home that S
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)
0
12 ... e
_1,1_5
DISTRIBUTION: Original-County Auditor. File-Stamped Copy -Taxpayer
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