HomeMy WebLinkAboutHomestead_Brown (31) ,: . CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
State Forth 5473(R77(1-16) HC10 [ O 9
\�� Prescribed by the Department of Local Government Finance r
INSTRUCTIONS:See averse side forfiing 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
(We) €Tl-v` ��- UJ in certify that I(we)occupied as my(our)principal
place of resid ce or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed onpe 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.
❑ 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.
(
\\ social number of claimant's spouse(( ).ti'vets I-�-t t ..:,cation(Other number of claimant's spouse past five digits) Issuing State
Shy I APPGca.1! y s spouse does not have a social security number.)
".(,� I
CONTRACT RECORDED
K • If buying on contract,Fee Simple owner's name (v�r,
�n� s7 P 2 4 2019
Recorder's office where contract is recorded , Record number Page
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"nl� County PROPERTY DESCRIPTION
e_ Township AUDITOR Taxing district(city,tower,M
Panxl.rnuryber Legal description .•..erty in question
LJVVJ % proper -
� �Income,
mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sunoa 1structure is u me,describe the use and portion
of the properly utilized to produce income.
iG Hl2- — —z0Z-0°3 . O.-1—'02 •
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is c1-Is_ t vacating a homestead?
IA,Yes ❑ No •
Signature of claimant /
I hereby certify the above statements are true,correct,and complete.
Address of contact(numberend street city,state,and ZiPcode) Address of vacated if / A� . city state,and ZIP code
I
ASSESSOR USE ONLY i ASSESSED VALUE HOMESTEAD VALUE f NON-R SIIDENTIAL
VAL
Land not exceeding one(1)acre immediately (1) :,i
surrounding residential improvements �.•_ :-.._-._ ..._.
i t
Other land (2) 4 '
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5) ,
a
Other improvements (6) „.,._.__
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month dais Year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay s Lesser of 60%of the assessed value of the homestead or$45,000. .
Notwithstan''+' I ' - provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not ass -al prope o a manufactured home that is not assessed as real property may
not exceed on- t 9)of the asse alue of the mobile home or manufactured home.
Signature of Audi A� ��1�., Date si d loath,day,yet
DISTRIBUTION:Original untyAudMr,Fib sped Co
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