Homestead_Lofton (3) 1 2-'a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR r
, STANDARD/SUPPLEMENTAL DEDUCTION FORM
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- State Form 5473(RI 5/1.20)
: HCI 0 v -
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.
‘(-y CERTIFICATION STATEMENT
I(We) (' !'") certify that I(we)occupied as my(our)principal
tlt.pp place of residence or am(are)b ring the following described real prop hales contract which a Homestead Property Tax Standard
,f Deduction is hereby claimed on the date this application is signed, `•j-Il (date of signature) I(We):
Q�� Xwn. ❑ Am(are)buying under recorded contract.
y�� i� m(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
\ �r)(1 0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
0 Am (are)the shareholder, partner, or member of the entity that owns the property.
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` .`'\\`r 1 Social Security number of daimanrs spouse(last five digits) Driver's license/Identificatic(n/Other number of claiman:s spouse(last five digits) Issuing State
(Applicable only if applicant spouse does not have a social security number)
1.,n1J‘- CONTRACT RECORDED
���` , If buying on contract.Fee Simple owner's name
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\\'1/\719 Recorder's office where contract is recorded�� Record number 'page
�'\ i 1 PROPERTY DESCRIPTION
County Township Taxing district(city town,township)
Parcel number Legal roscdpton Is th p pert)in question
I Real property ❑Annually assessed mobile home(IC 6-7 1-7)
If any portion of the residential structure or the land not exceeding one(I)acre that immediately surroi ds th structure is used to produce income.describe the use and portion
of the property utilized to produce income
2- 4 - ic) , - 2_,2 —) Or— ool ,( 017 - ol .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,county and Township i Is claimant vacating a homestead? j
❑ s ❑ NO
ignalure of d
I hereby certify the above statements are true,correct,and complete. y/7`
Address of contact(number and street.city state.and ZIP code) I Address of vacated homestead,f any(n mber and street,city.state,and ZIP code))
2--5 N) clSoU) 01v)`\\ - -n-- I. Gss
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2) 414.3/41 11
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) I
annually assessed mobile I ��
manufactured home Garage (5)
ibOther improvements (6) i
Total improvements(line 4 through line 6) (7) I G/e 0A ��(
C �a�
Total value (line 3 plus line 7) (8} QG�Q}�4.`y ,
I hereby certify the above is true,correct, Signature of Assessor Date signe '(?rig t}>�ay year)
and complete. l'e
Verifying action-Signature of Auditor Date signed(month.aed
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STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
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 °bile home or manufactured home.
Signature of Auditor ^ t s Date signed month.d y,year)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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