Homestead_Poe-Christie CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' ` '' -'�- STANDARD/SUPPLEMENTAL DEDUCTION FORM
','— ',:....,.4,:' State form 5473(R17/1-16) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for fifing instructions.
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
AL
CERTIFICATION STATEMENT
I(We)_ —rA :' rf e..'1 �)e.... ■� certify that I(we)occupied as my(our)principal
place of residence or am(are)buying a following described real property under contract for which a Homestead Property Tax Standard
Ded n is hereby claimed on the date this application is signed, (date of signature). I(We):
/�� ❑ 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.
CLAIMANT'S INFORMATION
Name ofrnant(legal n ) Telephone number of daimant
Y q,IPx 1e o&- (1,i S f t P� (Mid 7114- &z8 8
SocialSeauitynumberof t(lastlivedigits) Driver's license/dentification/Cher number ofdaimant(last five dgits) Issuing State
2./>„4 I (Applicable on/Dappticant does have a social security number) �^
Name ofelaimannt's�spouse(legalname)
SS Z AVI
Social Security number of claimants spouse(last five drgits) Driver's license I Identification/Other number of claimants spouse(fast five dgits) n I
(Applicable onlyifapplicant's spouse does not have a social security number.) .1
CONTRACT RECORDED '1�p
If buying on contract,Fee Simple owner's name J
SU
Recorder's office where contract is recorded Record number Page mF
t`1�'J
OR
YA a PROPERTY DESCRIPTION
County Tawnsh}}�� • T...., ct( faun, hip) GIB .V . -
bart.
Parcel numb9r1 t egal descripton la the p �tion• , •
t'.-.-ea1 property ❑.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 properly utilized to produce income.
PROPERTY'OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Q,Yes 0 No
ure Iclaimant 1. i / /,
I hereby certify the above statements are true,correct,and complete. L�%il���a/ i
Address of contact(numberend awe,city,state,and ZIP code) Addwss of vacated homestead,if any(numberarrd street,dry,state,gad Zl? 76
61)1
ASSESSOR USE ONLY i• ASSESSED VALUE HOMESTEAD VALUE NON RE L!QENTIAL
Land not exceeding one(1)acre Immediately
surrounding residential improvements (1) .._,._ •-
Qtherland (2) j
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) ,h-
annually assessed mobile!
manufactured home Garage (5)
Other improvements (6) „_ _•'; ,,,,i
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(month day,year)
and complete.
Verifying action-Signature of Auditor 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,fhe 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 property may
not exceed one-halt(1/2)of the assessed value of the mobile home or manufactured home.
Sign Auditor Date signed(month,day,year)
�� j-2719
ISTRI ON:Original-County warrior,File-Stamped Copy yer
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