Homestead_May ss ,, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
1.141.111 STANDARD!SUPPLEMENTAL DEDUCTION FORM
' State Form 5473(RI2/1-20) HC10 .
�j,—ra 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 STATEMENT
W.
I(We) , 4 1,, r r I certify that I(we)occupied as my(our)principal
place of residence or- (are)buying the following des.ibed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this applicati. is signed, (date of signature) I(1Ne):
❑ 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.
-
Recorders office where contract is recorded Record number ,Page
PROPERTY DESCRIPTION
County t 'el Township ± ;axing district(city.town.township)
Parcel number J� 1 Legal descriptioni Is lhlrperty in question
II Real property ❑ Annually assessed mobile home(IC 6-I I-7)
If any porton of the residential structure or the land not exceeding one(1)acre that immediately surro' ds th,t structure is used to produce income,describe the use and portion
of the property utilized to produce income
2..._Ci
1 — 1L1 — �'OZ 'Qn. . ..S — a 2 ,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County and Township Is claimant v.calin•. . omestead?
❑ Yes ji No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. y� / �7�/�
Address;f contact(�t:e�Q street y�fe and code) �1� � 49-6 ddress or va homeWste ,if any(number an reef,city state.and ZIP cod
22 I 1 ''1s n '
' NON-RESIDENTIAL 3 i
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I VALUE
Land not exceeding one(1)acre immediately (1) .
surrounding residential improvements "LED
Other land _(2) �,JTotal land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) S
annually assessed mobile I Jui{t 9 �20 A,,,,,:,.
Q n
manufactured home Garage (5) 'tl 1\PVC
Other improvements (6)
Total improvements(line 4 through line 6) (7) • / k.
Total value (line 3 plus line 7) (6) GIBS a �Y
CIS,
I hereby certify the above is true,correct Signature of Assessor AUDiTOR Dale signed(month.day.year)
and complete. I
Verifying action-Signature of Auditor Date signed(month.day year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
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(12)of the assessed value of the mobile a anufactured home.
Signature of Auditor \N '\ �� Date sign{6"( onµ„d r/-� i ..
0111\
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpaye
Page 1 of 2