HomeMy WebLinkAboutHomestead_Conner (4) , CLAIM FOR HOMESTEAD PROPERTY TAX / YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORMHC1 otOa
(N1111k:/./ Stale Form 5473(R19/1-23) .
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
I(We) L r-04-• _p Nre---r_ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the kit/eying Qescrib real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date thi application is signed. 1 " \-0 -p 3 (date of signature) I(We)
❑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
If Buying on Contract,Fee Simple Owner's Name
vt..... ) (:),s. -
Recorder's Office V1.15ere Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Tow hip Taxing District(city,town,township)
Parcel Number Legal Description Is the property in question
al Property 0 Annually Assessed Mobie Horne(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
CU -VR - 01)\ - ou 0,. L-S-scae._,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is Claimant Vacating a Homes d7
0 Yes a
l Signatu f Claimant
I hereby certify the above statements are true,correct,and complete Y1y\' /'y (/�
Address of Contact(number a •street.city state.an IP code) . Address of Vac i �s'tE6 ifarTy(lumber a a re.7 and ZIP code)
q --1 t 4 • r .. ' , . \-Al ‘-z • -
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL V LUE
Land NotExceeding One Acre Immediately (1)
Surrounding Residential Improvement — -- �
Other Land (2) C Q %6 r{.O�2J
Total Land(line 1 plus line 2) (3) �`` _L „tip)
Residential Improvements or Dwelling (4) I�`�JOj/\/lr e�
Annually Assessed Mobile I - �N(`� P
Manufactured Home Garage (5)
Other Improvements (6) G eelVN GO
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Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date,month.year)
I hereby certify the above is true,correct,and complete.
Verifying Action-Signature of Auditor Date Signed(date month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000
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(1/2)of the assessed value of the mobile home or manufactured home
Signature_at Auditor Date igned(month.day.year)
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DISTB al-County Auditor.File-Stamped Copy-Taxpayer
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