HomeMy WebLinkAboutHomestead_Bush a '0 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
(7X t"-STANDARD/SUPPLEMENTAL DEDUCTION FORM —
l`IT State Form 5473(R 19/1-23) HC10 742�
\ '� Prescribed by the Department of Local Gevernmert F,nance
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) e 11 0. - certify that I(we)occupied as
!•Drivers License!Identification Other Number of Claimants Spouse(last five dg ts) �Issuing State 4` `'!�
(Applicable only ifapplicant's spouse does not nave a social secunty number) `GT
4
CONTRACT RECORDED �jQ v
if Buying on Contract.Fee Simple Owners Name r CO C
Recorder's Office Where Contract is Recorded I Record Number i Page ���� Ql?
1.
PROPERTY DESCRIPTION OR
County - ` ^ -aain ct(city own.township)
1 Parcel Numberu \\\ O Legal Description /v\L Is the pr a inq a on
V
1❑Real Property 0 Annually Assessed Mobile Home(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
2_6 1 ___ escA -2 0 0 -0 0 .3.- • 6-3 \ . 0 2 ) .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is Claimant Vacat g Homestead,
- _ - - -
i ❑Yes No .__
X - S n
I hereby certify the above statements are[rue.correct.and complete
Address of Contact inumppr and street.city state an - _ o, ens o Vacated Homestead if any(number and street ity.state and ZIP code)
USg3OQlo - 6
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement__
Other Land (2)
Total Land(line 1 plus line 2) (3)
•
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home ( Garage (5) I _ _ I
Other Improvements (6) •� �^ — ^ 0 1 _00 0 1 q L\ —02\
Total Improvements(Line 4 through Line 6) (7)
j 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.
Venfying Action-Signature of Auditor •Date Signed(date month,year)
STANDARD DEDUCTION ALLOWANCE
•
20 Pay 20 Lesser of 60%of the assessed val..e (• _•-estead or 548 0:=
Notwithstanding any other provision the sum of the deductions provided in IC 6-t 1-12 to a mobile home that S
is not assessed as real property or to a manufactured home that rs not assessed as real property may not
exceed one-hall(V2)of the assessed value of the mobil ufactured home
Signature of Auditor Date Sign one,y an
Ni , 2�
DISTRIBUTION: Original-County Auditor Fite-Stamped Co -
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CLAIM FOR HOMESTEAD PROPERTY TAX