Homestead_Goodman CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
r
State Form 5473(R171 I-16) HCI0
Prescobed 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.
r CERTtncADON STATEMENT:'' - - . r. • s
I(we) Christopher&Ince Gcodman certify that I(we)occupied as my(our)principal
place of residence or am(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, silting (date 01 signature). 1(We):
I) Own. ❑ Am(are)buying under recorded contract.
O 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.
_ _ CLAIMANTS INFORMATION - ., ,
Name of clamant(legal name) Telephone number of damn
Tricia Goodman
Remmers office veers contract is recorded Record number Page
'PROPERTY DTSCgIPTION - 5,. ". :. �
Cony Township Taxing d'4tct(city(citytom.tomaNp)
Gibson Montgomery Montgomert+ _a_ ' D.
Parcel number Legal de Ismprion Is the property N question:
26-ie-06-300-005.455-021 I]Real popeny ❑ Annually assessed mottle home
�(IC
(v6�-(1.1-]D
If ary portion of the residestructurel structure or the landacreimmediately not exceeding one(I) thatimmediatelyW mi surrounds that sre is used to produce income,desmW the use alq/Arfon l 4 2019
of the property utilized to produce income.
b r l' -- Soo- o or. ss-_02 j A T' y AUDITOR
PROPERTYOWNED ELSEWHERE BYCLAIMANT.
Safe.Crony.and Township Is claimant vacating a homestead?
❑ Yes Q No
Signet re of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and Gee,city stare,and ZIP rods) Address of vacated homestead.if any(number and street,try,rate,and ZIP rode)
ASSESSOR USE ONLY." I - ASSESSED VALUE--
I.." HOMESTEAD VALUE a •I..^, NON-RESIUENTIAL
Land not exceeding one(I)acre immediately (1) . - -
surroundlnq residential improvements - -
-Other land (2) -
Total land(fine I plus line 2) (3)
Residential Improvements or Dwelling (4)
annually assessed mobile I
manufactured home Garage (5) _ - - __ .
Other improvements (6) - ' -
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct spnawn of Assessor Date Signed(month.day,Far)
and complete.
Verifying action-Signature of nucleic Oats signed(monk,day.Fan
STANDARD DEDUCTION ALLOWANCE' . . , ' -
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
Nobvdhstandirg any other provision,the sum of the deductions provided in lC 6-1.1-12 to a mobile home S
Nat 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 lame.
Signature of Auditor Date signed(monh,day,Fan
ILLN1 L'-S.-J J 05/14/19
WSTRIBUT1ON: Onginal-County Audtor.Fie-Stamped Copy-Ta+Cayer
Page 1 of 2