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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD I SUPPLEMENTAL DEDUCTION n
State Form 5473 (R2117-25) HC10 Prescribed by the Department of Local Govenmuenl Finance
INSTRUCTIONS: See reverse side for filing instructions.
NOTE Telephone, Social Security, diver'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) �� C����-1 �e 1 f�_� — 2�r,flAZW-�, I��C'1 certify that I (we) occupied as my (our) principal place of
residence or am (are) eying the fol 'ng described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
is application is signed, (date of signature)- I (We):
rdal
Own. []Am (are) burying 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 tinder the terms of a qualified personal residence trust -
Am (are) the shareholder, partner, or member of the entity that arms the property.
INFORMATION
Name of Claimant (legal name)
Telephone Number of Cla'vnant F1nail
Address
c
(gla) ? 7 --
Social - Number o Claimant (last five dgifs)
Livers License I Identification I Other Number of Claimant (last five digits)
(Applicable only 3applicant does not have a social security number)
Issuing State
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Name oUCIarmanifs Spouse (7egef name)
Social Security Number of Claimants Spouse (1ast five dgits) Dives license l Identification i Omer Number of Cwi aK3 Spouse (last five d7ft) Issuing State
(Applicable only 8applicant's spouse does nor have a social security number]
CONTRACT RECORDED
If Buying on Conb®cl, Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTYDESCRIPTION
County Township Taxing District (City, town, township)
—r—
(� l \ Q \
Parcel Number Legal Description Is
th roperty in question:
Rea" 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 surrarnds that structure is used to produce income, describe the use and portion
of the property utilized to produce Income.
PROPERTYOWNED ELSEWHERE BY CLAIMANT
State
Carrrty
Toµnstuip is ClaimantVacating a Horn ?
❑ Yes No
Signature of Claimant
1 hereby certify the above statements are true, correct, and complete_
��
Address of Contact (number and street state, and ZIP code)
Address aeated Homestead, ff any (number and street and ZIP code)
l60 �. I����G `,E j `17(a(a(o
ASSESSOR USE ONLY I ASSESSEDVALUE.
1 VALUE
NONRESIDENTIAL
Land Not Exceeding One AaIT mdiatly
(1)
l(m1)
m
Saroudin Residentialnt
Other Land
(2)
Total Land (Line 1 plus Line 2)
(3)
Residential Improvements or
Dwelling
(4)
Annually Assessed Mobile /
Manufactured Home
Garage
(5)
Other Improvements
(6)
Total Improvements (Line 4 through Line 6)
(7)
Total Value (Line 3 plus Line 7)
(8)
Signature of Assessor �/8
Date Signed (date, month, year)
1 hereby certify the above is true, correct, and complete.
$Q
Verifying Action — Signature of Auditor
onth, year)
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STANDARD DEDUCTION
For assessment dates after December 31, 2024: in 2025,
$48,000; in 2026, $40,000; in 2027, S30,000; II 2028, $20,000;
20 Pay 20
in 2029, $10.000; and beginning with the 2030 assessment date
and for each assessment date thereafter, $0.
$
Ncttv)thstanding any other provision, the sum of the deductions provided in IC 64342 to a
mobile home that is not assessed as real property or to a manufactured home that is not
assessed as rent property may not exceed one-half (112) of the assessed value of the mobile
home or manufactured home.
Signature of Auditor
Date Signed (month, day, year) ^^,,
DISTRIBUTION: Oricpnal — County Auddor, flleStamped Copy —Taxpayer
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