HomeMy WebLinkAboutHomestead_LloydA CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
�1 STANDARD / SUPPLEMENTAL DEDUCTION FORM
V State Form 5473 (R21 17-25) HC10
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.
CERTIFICATION
I (We) certify that I (we) occupied as my (our) principal place of
residence or am (are) buyinh the following descrided real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, (date ofsignature). I (We):
E 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)
Telephone Number of Claimant Email
Address
L ,
(�ja) a� 5 -oK�o�
Social Security Numbe of Claimant (last five gits)
Driver's License I Identification I Other Number of Claimant (last five digits)
(Applicable only ifapplicant does not have a social security number)
Issuing State
\
Name of Claimant's Spouse (legal name)
Social Security Number of Claimant's Spouse (last five digits) Driver's License Identification I 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 Owners Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTYDESCRIPTION
County
Township
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.
PROPERTYOWNED ELSEWHERE BY CLAIMANT
State County
Township Is Claimant Vacating a Homestead?
zy,.s ❑No
Signa ,r of Claimant
I hereby certify the above statements are true, correct, and complete.
y r l nad
` W9,
Address of Contact (number and street, city, state, and ZIP code)
Addr s f Vacat d H464stead, if% y (number and street, city. state, and ZIP code)
ASSESSOR USE ONLY
Land Not Exceeding One (1) Acre Immediately
ASSESSED VALUE
(1)
HOMESTEAD VALUE
NON RESIDENTIAL VALUE
Surrounding Residential Improvement
Other Land
(2)
Total Land (Line 1 plus Line 2)
(3)
Residential Improvements or
Dwelling
(4)
Annually Assessed Mobile /
Garage
(5)
Manufactured Home
Other Improvements
(6)
Total Improvements (Line 4 through Line 6)
(7)
Total Value (Line 3 plus Line 7)
(8)
Signature of Assessor
Dat (date, month, year)
I hereby certify the above is true, correct, and complete.
Verifying Action - Signature of Auditor S`OH
STANDARD DEDUCTION ALL
Dat Signed (date, month, year)
For assessment dates after December 31, 2024: in 2025,
0R
20 Pay 20 $48000; in 2026, $40,000; in 2027, $30,000; In 2028, $20.000;
in 2629, $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 -hail (112) of the assessed value of the mobile
home or manufactured home.
Signature of Auditor
Dale Signed (month, day, year)
DISTRIBUTION: Original -County Auditor, File -Stamped Copy -Taxpayer
Page 1 of 3
1