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- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD / SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R21 1 7-25) HC10 (.
Prescribed by the Department of Local Government Finar4_e
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.
jjj(((,,,��� _� CERTIFICATION STATEMENT
I (We) G � S elf _N • certify that I(we)occupied as my(our)principal place of
residence or a (ad)buying the 10.1 :1esq�ped mall p�pperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date is application a signed, tI �G 1 (dare of signature). I (We)
Own DArn (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 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
CONTRACT RECORDED
If Buying on Contract, Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township Ta • s' . (.' town,township)
CI) Sc . (X) L •�n
Parcel Number Legal Description s i • operty In question
KI Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7)
1 any portion or the residential structure or the land not exceeding one(1)acre that immediately su • •s th.t structure is used to produce income.describe the use and portion
of the property utilized to produce income
2_ G -20 - L\ -- 2,-0 o --0 0 2 . 2._-+-2.- o o \
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County Township Is Claimant Vacating a Horn s 7
❑Yes No
Signature of Claimant
I hereby certify the above statements are true. correct,and complete. r1y"
,..."4/€140.46
Address of Contact(nurrI and t. city. state. end ZIP code) A ress of Vacated H estead.if any(number and street,city state. end ZIP code)o2S- tr 48 ' - L\
In
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ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON RESIDENTIAL VALUE
Land Not Exceeding One (1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) FILEE) ,
Total Land(Line 1 plus Line 2) (3)
1 Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) DEC 3 0 2025
Other Improvements (6)
1 ,
Total Improvements(tine 4 through Uns 6) (7 ,
t.+� �1��rcvrc4/
Total Value(tine 3 plus Unto (BS3IBSON COUNT. ,
Y AtUDhT
Signature of Assessor Date Signed(date, month, year)
I hereby certify the above Is true, correct.and complete.
Verifying Action-Signature of Auditor Date Signed (date,month, year)
STANDARD DEDUCTION ALLOWANCE
For assessment dates after December 31. 2024. in 2025.
20 _ Pay 20 _ $48,000, in 2026, $40,000; in 2027,$30,000: in 2028,$20,000,
in 2029 $10.000, and beginning with the 2030 assessment date
and for each assessment date thereafter, $0.
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-haft(1/2)of the assessed value of the mobile
home or manufactured home
Signature of Auditor ' Date Si dak2.
ear)
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DISTRIBUTION: Original - County Auditor.File-Stamped Copy-Taxpayer
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