Homestead_Fithian (6) Reset Form
/et •-'`. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
., STANDARD ! SUPPLEMENTAL DEDUCTION FORM
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(*1
% Slate Form 5473(R20/ 12•24) H C 1 0 ,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) Pros�''T�sCt •, ✓\ certify that I (we)occupied as my(our)principal place of
residence or am(are)buying the I i . d s n d real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date tnis application is signed, A Z ".)r(3ate of signature). I(Wej
Own ❑ (are)buying under recorded contract
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
E Have a beneficial interest in the trust or the nght to occupy the property under the terms of a qualified personal residence trust
0 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 Distnci( "ty,t. n, township)
`�0 r1 ) _ Al 0-'\ .
Parcel Num Legal Descnption : .roperty in question.
jeal Property Amuaty Assessed Mobile Home(IC 6-1.1-7)
II any portion of the residential structure or the land not exceeding one(1)acre that immediately surf•.nds at structure is used to produce income.describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Va •tmg . omestead'
_. Yes 7 7 No
Sigrtalu of laimnt
_4..../ _ \
I hereby certify the above statements are true, correct,and complete.
r y r
A ress of Contact(number rid street. city stale. a d ZIPcode! Acdres of Va tad if Homestead fny rn,mbe �rd Shea' r): .St re a :'tp i' 1
ASSESSOR USE ONLY ASSESSED VALUE i HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement _ 1
Other Land (2)
Total Land (line 1 plus line 2) (3) ED
Fi
Residential Improvements or Dwelling (4)
Annually Assessed Mobile l
-
Manufactured Home Garage — (5) " , 2/10 2_6Other Improvements (6) '" l� v
Total Improvements (Line 4 through Line 6) (7)
•
(7.-
Total Value (Line 3 plus Line 7) (8) ,il.e . '.,r.
Signature of Ass i SON COUNTY AUDITOR 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
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 S
is not assessed as real property or to a manufactured home that is not assessed as real property may not
t exceed one-half(1/2)of the assessed value of the mobile home or ufactured home
Signature of Auditor A _ Date S^^ ^—
•-1- C--(7: 2!:%Ar- ‘.
DISTRIBUTION: Original-County Auditor.File-Stamped Copy -Tax
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