Homestead_Cousert (4) CLAIM FOR HOMESTEAD PROPERTY TAX
=` FORM YEAR
' � � STANDARD/SUPPLEMENTAL DEDUCTION
<` HC7t1
, �y�� State Form 5473(R77/1-16)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side forfifing instnudions.
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) _1 $.1 Q.n e.. . .Oki Se_c-' 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
Deductign is hereby claimed on the date this application is signed, .-I 1-`� (date of signature). I(We):
LW6 vn 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.
If buying on contract.Fee Simple owner's name •
Recorder's office where contract is recorded Record number Page 4, lilt \.-c
• 6 PiJO
PROPERTY DESCRIPTION _
Co my Township Taxing 'et(city,town,township`-�")
1 G sO\�
Parcel number Legal description Is the property in question: \�
0 Real property nnuailyassessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceedng one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income,
o)Lp — cD.O- O 300--' .- 'ot:qq - 00i
l�\� r
PROPERTY OWNED ELSEWHERE BY CLAIMANT
V
State,County,and Township Is ctaiman ' g a homestead? .
es ❑No
Signature of claimant p✓
I hereby certify the above statements are true,correct,and complete. K)(m ; �
Address of contact(numberand sleet city,state,end ZIP code) '.4--of aated homestead,if any(numbererd street,city,state,end ZIP code)
f NON-RESIDENTIAL
ASSESSOR USE ONLY i ASSESSED VALUE } HOMESTEAD VALUE VALUE
Land not exceeding one(1)acre Immediately (1) (( , +
surrounding residential improvements
Other land (2) - ., z 5R kpjr 1,....
Total land(line 9 plus line 2) (3) �
Residential improvements or Dwelling (4) t'
`c annually assessed mobile i
manufactured home age (5) < v
Other improvements (6) t . p„ / ,-.,
J
Total improvements(line 4 through line 6) (7) -
Total value(line 3 pits lira 7) (6) G/I3S O r.�
I hereby certify the above is true,correct, Signature of Assessor Date signed(month: r3
and complete. 7 Y q(/DiT
Verifying action-Signature of Auditor Date signed(month,day,year) �R
STANDARD DEDUCTION ALLOWANCE g4r,\e.u) .
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. 1..(I .1
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 properly or a manufactured home that is not assessed as teal property may
not exceed one-half(i/2)of the arse value of the mobile ho ormanufectured home. -Sitar Date signed(month,day,year) 911
I
#181.-.4--)• q
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DISTRIBUTION:Original-CountyAuddor,File-Stamped Copy-Taxpay
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