Homestead_Petitjean (1! CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION HC70
State Fonn 5473(R17I 1-16)
, Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,dnve(s license,state idenwfcabon and federal idenb.cation numbers are confidential under IC 61.I-12-37.
_ CERTIFICATION STATEMENT . -,n_ _. .
I(We) Cody I c Jennifer S Pabgean 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, (date of signature). I(We):
O Own. 0 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.
lam._t., - .`, H. i1,:,CLAIMANPS INFORMATION. `T - �,c_ hone's nth
Name of claimant(legal name) Telephone nurturer of da'manl
Cody L Petitjean ( )
Jennifer S Petitjean
Recorders office Mere canna is recorded Record number Page
.Set: (ty -r;; •_ -• _:-:PROPERTY DESCRIPTION `,i..S.[: s ,. nor- S _
County Township Taxing disaid(city,town,township)
Gibson Johnson
Parcel number legal description Its the property in- <sbon:
I Ci,ea p -1, QmN
o, � Aua assessed=tee home(IC 61.1.7)
If am port on of the restental structure or the land not exceeding one(1)acre that latsedtat so and - : i•to produce noon*,describe to use and poison
of the property utilized to produce income. 1L
26-23-16-400-001.037-024
JUN 2 6-2019
1 r " `:' - PROPERTY OWNEDELSEWNERERYCLAIMANT w . `
State.County,and Township I e/ Is dab-Dant vacating a homestead?
gPM1Oa ❑ Yes 0 No
GtBSON galaT,LAUDITO1
I hereby certify the above statements are true,correct,and complete. n a ADA-
Address of conttd(number erg sleet,cry,stale,and ZIP code) Address of vacated homestead.4 any(number and weer,cm,state,and ZIP code)
12742 S 200 E, Haub, IN 47629
-_,ASSESSOR USEONLY I `'-'ASSESSED VALUE' I- HOMESTEAD VALUE:..'Sf :NON-RESIDENTIAL
Land not exceeding one(1)acre immediately (1) - -
surrounding residential improvements
Other land (2)
Total land(line I plus line 2) (3)
Residential Improvements or Dwelling (4) . .
annualy assessed mobile I 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. Signature of Assessor Date signed(moan,day yea.)
and complete.
vertni g adbn-Signature of Auditor Date signed(moan,day seal
- . f°.' -. -STANDARD DEDUCTION ALLOWANCE, _ a,4-: . '
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45.000.
Notwithstanding any other provision,the sum of Me 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(1/1)of the assessed value of the mobile home or manufactured home.
Signature of Auditor C Date signed(mash,day year)
vinervv-v,Sm 0-1 GYS 6-26-2019
DISTRIBUTION:Ongnnal-County Auomar,FileStampeo Copy-Taxpayer
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