HomeMy WebLinkAboutHomestead_Brown ^•v. CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
y` ; STANDARD/SUPPLEMENTAL DEDUCTION FORM
5. ,,' State Form 5473(R1711-16) HOW 2019
;,. d Prescribed 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.
CERTIFICATION STATEMENT ,1
I(We).Jeremy w Brown certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property,eerier contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
. ❑� Own. ❑ Am(are)buying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation?
O 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.
,
Nam of claimant's spouse(legal name) 4 ` �• aw _`
• a
Social Security number of claimant's spouse(last rive digits) Drivvoer's license!Identification!Other number of claimant's spouse(last five digits) Issuing State
SE P`!g l rablq pgl�jfapplicant's spouse does not have a social security number.)
U CONTRACT RECORDED
If buying on contract,Fee Simple owner's name ^
Recorder's office where contract is recor�9 B SO/NN COUNTY AUDITOR. Record number Page
• PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Gibson Patoka Princeton
Parcel number Legal description Is the property in question;
26-12-18-203-000.121-028 ❑� Real property i'❑Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
-__-- . of the property-uEized.to.prndnca income - - - - - -.—. - — -. - 1 --•----- — _._,_
07- Ig —2o JOcoo. ,\2\ _ 02z
•
j( PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township •
Is claimant vacating a homestead?
❑ Yes • No
,`Signature of claimant 2
I hereby certify the above statements are true,correct,and complete. �/
Address of contact(number and street,city,state,and ZIP code) Address o a�dv ho ad,if any(numbe and street,city,Qstate,and ZIP code) ( 9 ( - _
ASSESSOR UISE ONLY ASSESSED VALUE HOMESTEAD VilLUE 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 Dwelling (4)
annually assessed mobile I
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through fine 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE I
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstandin• .l other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not ass' d.s real property or to a manufactured home that is not assessed as real property may
not exceed on•ilf 1/2)of the assessed value of the mom home or manufactured home.
® I Date signed( nth,day,yla
Signature of Audit�f. ,
*`M1 �q
DISTRIBUTION:Original-County Auditor,FileSta ed Copy-Taxpayer
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