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CLAIM FOR HOMESTEAD PROPERTY TAXSTANDARD I SUPPLEMENTAL DEDUCTION
State Form 5473 (R21 17-25)
Prescribed by the Department of Kcal Government Finance
FORM YEAR
HC10
INSTRUCTIONS: See reverse side forB6ng inshuctions-
NOTE- Telephone, Social Secunly, driver's license, state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I (We) OVIK a -A 15 certify that I (we) occupied as my (our) principal place of
residence or am (are) buying the faibwing described r�i pproperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, .�- (- Z0 Z.Co (date of signature)- I (We):
Flown. Am (are) buying under recorded contract-
[] Am (are) entitled to occupy as a tenants of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the tams of a qualified personal residence trust.
❑Am (are) the shareholder, partner, or member of the entity that owns the property.
INFORMATION
N n ) Claimant (legal
T Number of Claimant Email Address
Mr S
PIP -a ► r7
Social Security Number of Claimant (last five dugfts)
Drivers License I Identification I Other Number of Claimant (last five digit)
Aprrcbea'yffeplatdcetnonam0--&*7d
Issuing State
6--14�8
Name of Claimant's Spouse pegol name)
Social Security Number of Claimants Spouse (lest five digits) Ortvrls license l Werti•catien I Other Number of Claimants Spouse (t" me dipfs) Issuing State
µtpphcable only AapplicanFs spouse does not have a social security number)
CONTRACT•1 1
If Buying on Contract, Fee Simple Owners Name
Retarders Office Where Contract is Recorded Record Nranber 6 5 q Page
PROPERTY DESCRIPTION
County G) I Tawrohip Taxct (city, town, township)
�r(J� �RCZ>7C! SC.I f i' WC4 x p
Parcel Number
Legal Description Is
property in quea>ion:
�) ,. J . I �D • flh/� •
1 •, /�m�
eel Property ❑ Annuauy Assessed Mobile Home (IC 6-1.1-7)
If aany(y portion of the residential structure or the laird not exceeding one (1) acre that immediately surnxirids that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPERTYOWNED ELSEWHERE BY CLAIMANT
State Corm p Township r Is C mant ' g a Homestead?
�u.f� '\ ,fOy' G �y Yes ❑No
f�VV "1
Sionallure ofCW
I(/hereby above statements are true, correct, and complete.
`the
ycertify
Address of ContactG (C -� ,/ 4 tity. state; and LP mfe�� 76 1
i
zk A h 6+' +, I r tl.� r ✓ , f l( 11,sfata, and code)
Wr ` )l- 46r51
ASSESSOR USE ONLY
ASSESSED VALUE
HOMESTEAD VALUE NONRESIDENTIAL
Land Not Exceeding One (1) Acre Immediately
(1)
Suaroundin Residential
Other Land
(2)
Total Land (Line 1 plus Line 2)
(3)
Residential Improvements or
Dwelling
(4)
Annually Assessed Mobile I
Manufactured Home
Garage
(5)
Other Improvements
(6)
Total Improvements (Litre 4 through Line 6)
(T)
Total Value (Line 3 plus Line 7)
(8)
Signature of Assessor
Date Signed (date, h, yen
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, S40,000; in 2027, $30,000; in 2028, $20,000;
in 2029, $10,000; and beginning with the 2030 assessment date
and far 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-half (112) of the assessed value of the mottle
home or manufactured home.
afAurfdor
a"5-1
Date Sngned(monh,daY,Ye�J
a c�
ID STRIBUTION: Original —County Auditor. FdeStamped Cagy—Taxpuly
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