Homestead_Eskew CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' STANDARD J SUPPLEMENTAL DEDUCTION FORM
:t �,`" State Form 5473(R17/1-16) HC70
Presaibed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security drivers license,state identification and federalldenhTrcation numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
� Imo,
(We) /, ��.. certify that I( - , •p1 .as m k r),; t
place of reside .r- - am(are)buy- g the following described real property under contract for which a ''•mes;-•;:roc- , T :;,(i .
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract S E P 2 4 2019
❑ 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. I ,
��/
Social Security number of claimants spouse(last five digits) Driver's license/Identification I Other number of claimants spouse(fast five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Tasting d 'c[(�C town,tovatship)
Parcel number Legal description 7,b i R.L Isth raperty in question:
PT A to N t) 5 -3- 9 Real property ❑Annually assessed mobite home VC 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 utilized to produce income.
6- do- 0.5 / a 6 - t)e)Di. bD3 -od /
PROPERTY OWNED EL SEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
0 Yes ❑No
I Ignature � ^y/c`�
hereby certify the above statements are true,correct,and complete. � -of claimant k
Address of contact(numberand street city,state,and ZIP code) Address aft!.•home , any(rmmberand street,city,state,and ZIP code)
`" 756 41rn x17 {9
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE f NON-RESIDENTIAL
VAL
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements
Other land (2) . ,.t -,.>
Total land(line 4 plus tine 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile I 4;
manufactured home Garage (5)
•
Other improvements (6) a ,,.,,_
Total improvements(line 4 through line 6) (7)
Total value(line 3 pits fine 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auctitor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
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 property or to a manufactured home that is not assessed as real properly may
not exceed one-half(112)of the assessed value of the mobile home or manufactured home.
Signature fAuditor Date signed(month,day,year)
.,,er...,
BUTI1'
DISTRIBUTION:Original-CauM dd yAuor,File-Stamped Copy-T�Yet
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