Homestead_Swenson CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
! STANDARD I SUPPLEMENTAL DEDUCTION F�
7�• State Form 5473(RI?I i-16) HC 10 2019
Prescribed by the Department of local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Secuny,drivers license,state identification and federal idendficarron numbers are confidential under IC 6-1.1-12-37.
,T CERTIFICATION STATEMENT :.. ..
I(We) Swan a Ulan swmagn 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, oays/15 (date of signature). I(We):
* 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.
_ - CLAIMANTS INFORMATIONn . ..• _ •
�. •.• - .
Recorders o3ce where contract is recorded Record number Page
- .`i " ; PROPERTY DESCRIPTION. : % l i
County Township r Taxing dated(dig,town.township)
Gibson Col ' '' ilME
Parcel number Legal desml%ion Is the yopeM is question: (ern
261}1}104005.139506 ❑� Real popery 0 Mrgrfgy assetd/-,tVa�p��]��bhome(IC 6-1.1-n
If any poem of the resd or entat structure or the land not exceeded one(1)acre that iareastely surrounds that structure is used to duce morn..describe Muse and porton
Of the pomM utlzed 10 pWuce interne.
Gieso cONNT
She.County.and Townanp Is claimant vacating a homestead?
() Yes 0 No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and.Over coy,stare,and ZIP Code) Address of vacated homestead,if any(number and sheet,cry date,and ZIP code)
10692 E 100 S, Oakland City, IN 47660 507 Swan Dr, Dyer, IN 46311
ASSESSOR USE ONLY _- I. ASSESSED VALUE I; HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1) '
surrounding residential improvements
•
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Nettling I(4)
annually assessed mobile I
manufactured home Garage I(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(moron.day lean)
and complete.
vc}vtg action-signature of suCett Date signed(month,day year)
t_t 1,-d,/1 09/09/19
•. _x. - 'STANDARD DEDUCTION ALLOWANCE.) }1'
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545.000.
NaMithsMndirg any other provision,the sum of the deducbons provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a nwnu:aaured home Nat is not assessed as real property may
not exceed one-half(112)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Dale signed(moon.day.year)
09/09/19
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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