Homestead_Petitjean (10) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
; 1 STANDARD/SUPPLEMENTAL DEDUCTION FORM
M4' Slate Form 5473(R1711-16) HC10 2019
- u Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Secunty driver's license,state identification and federal identification numbers are confidential under I
I(We) Eii ee A PeSgena cacti that w ur)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, dagat19 (date o7 �,��r�n) I(We):
( Own, ❑ Am(are)buying under recorded contract. AUG 1 ""'
❑ 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 -lifiep •vat.•-il -••ence trust.
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. ilea
' CLAIMANTS INFORMATION „ _ k,T •'�ttt��a}" ' ' •_
Name of claimant(legal name) Telephone norther of claimant
Emilee A Petitjean ( )
Social Seanty number of gasmans spouse(last five dgfa) timers license/Identification I Other number of claimant's spouse(last five ages) ',sung State
(App&cabfe only rl applicant s spouse does not nave a social security number.)
•
1 _ _, -- .CONTRACT RECORDED -
t1 hang no convect,Fee Simple owners name
Recorders Mice Where coroact is recorded Record number Page
PROPERTY DESCRIPTION .
County _ -
Cmty Township Taxingamble,key ro ah , w".township) -
Gibson Johnson
Parcel number Legal description Is the property in question:
26-23-t 6-400.001.617-024
I]Real properly D Annually usenet modle some(IC 61.1-7)
If any ration of the reegental stNCGre or the land not esceedug one(1)acre that immediately surrounds that swuWre is used to produce mmme,desmbe Pe use and portion
of the property mated to produce income.
. ,L,,`t :_ • PROPERTY OWNED ELSEWHERE BY CLAIMANT•-•.` - '
State,County.and Township Is claimant vacating a homestead?
❑ Yes N No
Signature of clamant
I hereby certify the above statements are true,correct,and complete. i
L
Address of contact(numberare street cry,bate,and ZIP code) Address of vacated homestead.d any(number and Mast cry dare,and ZIP mad)
12810 S 200 E, Haubstadt, IN 47639
ASSESSOR USE ONLY- I ASSESSED VALUE I - HOMESTEAD VALUE yi ` NON VALUEN11AL
Land not exceeding one(1)acre immediately (11 , -
surrounding residential improvements -
Other land (2) -
Total land(line 1 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. Signature of Assessor Date signed(month dap WO
and complete.
Ve iytng action-Signature of Ntddor Date signed(month,day yeah
/ nc d-..13r-/ 081419
- STANDARD DEDUCTION ALLOWANCE >. ..
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45.000.
Notwlthstandirg any other provision,the sum of the deductions provided in IC 6.1.1-12 to a mobile home S
Nat is nor assessed as real property 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.
Sgnaturs of Auditor Date signed(monk day year)
A /vac 08/14/19
DeSTR1E10110 ,Orgnal-County Auddor,File-Stamped Copy-Taxpayer
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