Homestead_Linnie ,..6h+q CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
q+ 1i STANDARD/SUPPLEMENTAL DEDUCTION �)�
siiip State Form 5473(R16/1-20) HC10 /'�0 22_
r'� 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) • YL )n'1L 1 certify that I(we)occupied as my(our)principal
place of residence-a (are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
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 Township ` e Taxing district(city town,
u�a�(p)
�-- `
Parcel number Legal ion 'VC)
�\ Is t roperty in question:
I Real property ❑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 surrou ds th t structure is used to produce income,describe the use and portion
of the property utilized to produce income.
ZC — OS-- — C71 --- 2o0- 0o2 TT.5—g (913.—
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant va li g a homestead?
Yes No
Signature of claimant ' n
I hereby certify the above statements are true,correct,and complete. ��/ 1V�M`{'\_I Jk-'
Address of contact(number and street city state,en ZIRco e) Addressvacated homestead.if any(number and street,city state.and ZIP code)
63y• s'� 6s 1 ` ^- ..m -
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements -
Otherland (2) D
Total land(line 1 plus line 2) (3) __
Residential improvements or I Dwelling (4) —�
annually assessed mobile/
manufactured home Garage (5) lt'r' �t
Other improvements (6) 'Y U V 9 O2C
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6) 1 �(
.6101a
I hereby pletify the above is true,correct,
Signature of Assessor IBSONCOUNTYAJDaITOR(mourn,dayyear)
and complete. - -- - - --- - Date signed(month,day,year)
Verifying action-Signatureof Auditor
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 i ssessed as real property may
not exceed one-half /2)of the a essed v I e of the mobile me man actured home.
Signature of Auditor ,t% 1/PwJ DR al n d(mon da_y,rear)
CA
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2
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DLSTROUT1ON:Cigtel-Carey Ames,Re-te, d Copy-re>pafa
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