HomeMy WebLinkAboutHomestead_HarBison (2)CLAIM FOR HOMESTEAD PROPERTYTAX
a�� E STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R21 17.25)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS. See reverse side for filing instructions.
NOTE. Telephone, Social Security, driver's license, state iden6Fcallon and fadaml lda. im—n—
FORM YEAR
HC10
CERTIFICATION
certify that I (we) occupied as my (our) principal place of
residence or am (are) buying the following described real property under contract for which a Homestead Property Tax Standard Deduction Is hereby claimed on the
date is application Is signed,
(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
Neme of Claimant pegalname)
Telephone Number of Claimant
Email Address
Social Security Number of Claimant (last five digits)
Drovers cerisei Iderouricauch i Other Number o lalmant (ast love g s)
(Applicable only if applicant does not have a soc/el security number)
Issuing Slate
Name of Claimant's Spouse (legs name)
Social Security Number of Claimant's Spouse (last five digits) D rs se Identlficaiion at umber ofClalmanrs Spouse (astrrve gBs Issuing State
(Applicable only if applicant's spouse does not have a social security number)
CONTRACT••• .
If Buying on Contract, Fee Simple Owner's Neme
Recorders Office Where Contract Is Recorded
Rewrrl Number
PROPERTYDESCRIPTION
Page
County
Township
Taxing District (city, town, lownship)
Parcel Number Legal Description Is the party In question:
ro
Real Property ❑ Annually Assessed Mobile Home (IC 6-1.1.7)
Iran y portion of the residential structure or the lend not exceeding one (1) acre Utet Immedlalely surrounds that structure Is
of the property utilized to produce Income. used to produce Income, describe the use and portion
CCO, l":�'3-Q16Q
..
611
State County
Township Is Claimant Vacating a Homestead?
❑Yes Lt�No
I hereby certify the above statements are true, cored, and complete.
sign a of c Im t
Address o1 Contact (number and street, c* state. and Z1P code res Vaca d Homestead, if any (number and street city, state, and ZIP code)
c�� \• Inc. ,
t�� 7(" 7C�
ASSESSOR
Land Not Exceeding One (1) Acre Immediately
Surround Res identlallm rovement (1)
Other Land
(2)
Total Land (Line 1 plus Line 2)
(3)
Residential Improvements or
Annually Assessed Mobile /
Dwelling
(4)
Manufactured Homo
Garage
(5)
Other Improvements
(6)
SEP
Total Improvements (Line 4 through Llne 6)
(7)
Total Value (Line 3 plus Line 7)
(8)
hereby certify the above Is true, correct, and complete. Signature of Assessor
G18SON Co
to e, month, year)
Verifying Action — Signature of Auditor
1911
Date Signed (a e, o Ayear)
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 reel property may not exceed one-half (112) of the assessed value of the mobile
home or manufactured home.
Slgnaturg of Auditor
Date Signed (month, ds , year)
;ny(
•••- u 6-1— uu,y Auditor. r•ne-cramped Copy —Taxpayer
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