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CLAIM FOR HOMESTEAD PROPERTYTAX a �� STANDARD /SUPPLEMENTAL DEDUCTION FORM YEAR
•�� Slate Form 5473 (R21 / 7-25) HC10 Z
�a 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.
I (We) V -31-1\ ' _nir r U certify that I (we) occupied as my (our) principal place of
residence or am (are) buying the fo}�Qwing described re I property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date t ' application is signed, `'•1—.Q (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
Name of Claimant (legal name) T� phone Number of Claimant Emall Address
Social Security Number of Claimant (last five tligits) ver s )cense Id-mircation�her Number o Claimant (last live digits) Issuing Slate
(ppl'cable only if applicant does not have asocial security number)
Name of Claimtantnt's spouse (legal name)
Social Security Number of Claimant's Spouse (last five digits) Drivers License Identification / er Number of Claimant's Spouse (las[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
County nshlp I Taxing District (city, town, township)
C-o- V
Parcel Number Legal Description Is the property in question:
eat 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-C� L4no--la'I- IZ�-0a .
PROPERTY
State County
Township Is Claimaa Vacating a Homestead?
fnt
❑ No
I hereby certify the above statements are true, correct, and complete.
Signa yre.of Claimant
/
ti� n
r,
/
Address of Cont t (number and street, city, state, and ZIP code)
Address Vacated H ad f any (number and street, city, stele, and ZIP code)
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ASSESSOR USE ONLY
Land Not Exceeding One (1) Acre Immediately
Sunoundin Residentiallm rovement
(1)
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 (Line 4 through Line 6)
(7)
Total Value (Line 3 plus Line 7)
(g)
1 hereby certify the above is true, correct, and complete.
Signature of Assessor /�
c !f
Date S te, m h, year)
Verifying Action —Signature of Auditor
(date, month, year)
STANDAR.DEDUCTION ALL
aSigned
For assessment dates after December 31, 2024: in 2025.
20 pay 20 in 0 in $20,00
$40and
202 1
O�/l/�
in , ,000: beginning
In 2029, $10,000; and beginning with the 2030 assessment date
ng with the 3 assessment t
and for each assessment date thereafter, $0.
q
�o�%�
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
n
O�
assessed as real 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)
n
-----.._.-. _..y..,... ....,.,.r -mpea ropy— taxpayer i n
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