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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
FORM
YEAR
a'
Stale Form 5473 (R21 /7-25)
HC10
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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 1 1 6-1.1-12-37.
CERTIFICATION
I (We) �--�• •t certify that I (we) occupied as my (our) principal place of
residence or am (are) buying the following desc ed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, 9 ^ a n Le • (date of signature). I (We):
L.Bd n, [:]Am (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.
INFORMATION
Name,, of Claaiimant (legal name)
T hone Number of Claiman Email Address
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Social Security Number of Claimant (last five digits)
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Drive cense I Identification / Other Number or Claimant (last the digits) Issuing State
(Applicable only if applicant does not have a social securi number) y
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Name of Claimant's Spouse (legal name)
Social Security Number of Claimant's Spouse past five digits) Drivers License Identification /Other Number of Claimant's Spouse (last five digits} Issuing State
(Applicable only if applicant's spouse does not have a social security number)
CONTRACT•-•
If Buying on Contract, Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTYDESCRIPTION
County
T shl*p
Taxing District (city, town, township)
Parcel Number
Legal Description Is
the property in question:
❑'Real 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, describe the use and portion
of the property utilized to produce income.
I.
• a fO� �� a Z>� N
' OWNED ELSEWHERE BY CLAIMANT
PROPERTY
State
County
Township Is Claimant Vacating a Homestead?
❑y9f Mtvo
Signal re C 'man
1 hereby certify the above statements are true, correct, and complete.
Address of Con (nu and street, city, state. and ZIP ode _
A ress of Vaca d Homest d, if n (num er and street, city. state, and ZIP co
QLV
r�
• •
•
• •
•
Land Not Exceeding One (1) Acre Immediately
(1)
SurroundingResidentialImprovement
Other Land
(2)
`ate
Total Land (Line 1 plus Line Z)
3+� 1
Residential Improvements or
Dwelling
(4)
Annually Assessed Mobile I
�(3)
Manufactured Home
Garage
(5)
Other Improvements
(6)
J
Total Improvements (Line 4 through Line 6)
(7)
Total Value (Line 3 plus Line 7)
(8)
Gig
is and complete.
Signature of Assessor G�
a d te, month, year)
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1 hereby certify the above true, correct,
Verifying Action - Signature of Auditor
STANDARD DEDUCTION ALL
Date Signed ( jrponth, year)
For assessment dates after December 31, 2024: in 2025.
$48,000; in 2026, $40.000; in 2027, $30,000; in 2028, $20,000;
20 Pay 20
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-half (112) of the assessed value of the mobile
home or manufactured home.
Signature of Auditor
•
Dat Signed (mont ay, year
DISTRIBUTION: Original - County Auditor, File -Stamped Copy -Taxpayer / h�
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