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e,I CLAIM FOR HOMESTEAD PROPERTY TAX
j STANDARD / SUPPLEMENTAL DEDUCTION
C:eoJ Slate Form 5473 (R21 t 7-25)
Prescribed by the Department of Local Government Finance
FORM
� YEAR
HC10
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
I (We) certify that I (we) occupied as my (our) principal place of
residence or am (are) buying the followin described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, / " 2 ��.! � (date of signature). I (We):
Own. ❑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
N me of Claimant (legal name)
Telephone Number of Claimant
Email Address
A 0�5
6170 779' '
Social Security Number of Claimant (last rive digits)
Driver's License I entifiration Other umber of Claimant (last five digits)
(Applicable only if applicant does not have a social security number)
Issuing State
(-" /0a 44,
Name of Claimant's Spouse (legal name)
Social Security Number of Claimant's Spouse (last five digits) Drivers License Identification / Other Number of Claimants pouse (last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number)
If Buying on Contract, Fee Simple Owners Name
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY
County Township Taxi n District (city, town, township)
_0" -w�,s a.�o L�nS
Parcel Number Legal Description Is the pro rty in question:
^,.,
26 ! 2 -1(o IO I s o l .-j 5' 0.217 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.
PROPERTYOWNED
Slate County
Township Is Claimant Vacating a Homeslead7
❑Yes No
Signature of Clalma ,/'►
I hereby certify the above statements are true, correct, and complete.
_/J J�
ss o Con .1 y,
Address o a4ted omestead, if any (riumberand street city, state, and ZIP code)
15A5 ale eealrk k • �Ltnlc�f�/l TJ 47
�D'
ASSESSOR USE ONLY
Land Not Exceeding One (1) Acre Immediately
ASSESSED VALUE
(1)
HOMESTEAD VALUE
Surround in ResidentialImprovement
Other Land
(2)
Total Land (Line 1 plus Line 2)
(3)
Residential Improvements or
Dwelling
(4)
17-1
Annually Assessed Mobile I
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
Dale Signed (date. m
I hereby certify the above is true, correct, and complete.
Verifying Action -Signature of Auditor
STANDARD DEDUCTION ALL
Date Signed (date, month, year)
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-half (112) o1 the assessed value of the mobile
home or manufactured home.
Signat aPofAuditor
Date Signed (month, day, year)
F-11_aDRLO
aDISTRIBUTION: Original —County Auditor, File -Stamped Copy —Taxpayer
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