HomeMy WebLinkAboutHomestead_Johnson (14) " CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a._r.-S STANDARD/SUPPLEMENTAL DEDUCTION FORM
1' State Form 5473(R15(5-14) HC10
Prescribed by the Department of Local Government Finance
I 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 - 'C - '
I(We) '�!�SI��I ii I�L�(/����J is-V!i — certify that I(w I Fed-.s ,4 ur .d Mr t
place of--si s7e-or am -re)buying the following de- bed real .roperty under contract for which a : est-•-• -roperty Tax Standard
Deduction is hereby clai• ed on the date this application is signed, (date Of signature). I e_t
❑ Own. ❑ Am(are)buying under recorded contract. AUG 5U
❑ Mn (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 tonal re i e MDSt.
❑ Mn (are)the shareholder, partner, or member of the entity that owns the property. JT•+Ie(,wne
- .--. _
g Prying on connect,Fee Simple owner's name
Recorders of a where contact is recorded I Record number 1 Page
County Township Toxin��)sai`d((a'lyy llosw ttos.nos::o)
Panel number Legal desoirton I Is the property in goeshen:
el- $w l -a. •t t s So 4- c. ❑Real property ❑Annual)/assessed mobie Mme(IC 6-1.1-7)
If any canon of the residential stnuctae or the land not escoMug one(1)acre that immediately surrounds that gmcture s used to produce income,describe the use and portion
of the popery diced to produce inarne.
,2 (a - // - Ol - /DD - o03. 7 1-6 -047
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sax,Corny,and Townshp Is claimant vacating a homestead?
///��� ❑ Yes ❑ No
I hereby certify the above statements are true,correct,and complete. K /
Address of contact(number and street,My,stare,and ZIP code) Address of vent,- c - cad,fan y.- and street,cry,gate,aand ZIPcpde)
P/1.-ti 1 • .-
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE--I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately I(1)
surrounding residential Improvements
Other land 1(2)
Total land(line I plus line 2) 1(3)
Residential improvements or Dwelling I(4)
Annually Assessed Mobile I
Manufactured Home Garage I(5)
Other improvements (6)
.
Total Improvements(line a through line 6) ,(1)
Total value (line 3 pits line 7) (5)
I hereby certify the above Is tone,correct, Signature of Assessor Dare signed(north,day,year
and complete.
Mashing aeon-Signature of Audttor Date signed(owdh,day,yea)
c •—;: - -_: 1s:-•_ . =_ ':STANDARD DEDUCTION ALLOWANCE==i - ;a-.a4. °"'+-" ='- _s::=.._
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-1210 a mobile home $
that is not assessed as real properly 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 of ....Auditor L r ) Dee signed Grath,day,year
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DISTRIBUTION: Orgial-Corny AUdtcr,FieSamped Copy-Taxpayer