Homestead_Southall CLAIM FOR HOMESTEAD PROPERTY TAX FORMYEAR
" STANDARD/SUPPLEMENTAL DEDUCTION
\ - f' State Form 5473(R17/1-16) Hel° 2Q`c(
Prescribed by the Department alLocal Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE Telephone,Social Security,driver's license,state identification and federal ide caffon numbers ate confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
t(We) L en, i • 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
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
►v. Own. ❑ Am(are)buying under recorded contract
is .m(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
0 Am(are)the shareholder, partner,or member of the entity that owns the property.
Recorder's office where contract is recorded Record number Page
I/
PROPERTY DESCRIPTION
County (5 Q,^ Township ` """ - - - Taxing district(city,town,township) •
Parcel tam r rr ' Legal description Is the property in question:
El Real property 0 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.
a(1 - k3-,2:97---3 OO OOO S 11- --cam oG.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township .ceding a homestead?
—, ❑ Yes ❑ '•
��ignatare of d-''r •
I hereby certify the above statements are true,correct,and•• -. �:� �
Address of contact(numberand sbee;city,state,and ZIP code)/ l -.. rnestead,if any(num•, and sheet,city, - - •- de
.t 3
c : 4• as d , ' )
Jn _ CtIT- 3Y
ASSESSOR USE ONLY 1 ASSESSED VALUE I HOMESTEAD VALUE ` NON RVESIIDENTIAL �1 1
Land not exceeding one(1)acre Immediately (1) t u
•
surrounding residential improvements
Other land - (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/ ..4
manufactured home Garage (5)
Other improvements (6) „;
Total improvements(line 4 through line 6) (7)
Total value(line 3 pits 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 esser of 60%of the assessed value of the homestead or$45,000.
Notwithstanding any erp sion,the sum of the deductions provided in IC 6-1.1-12 fo a mobile home $
that is not assessed a al petty or to a manufactured home that is not assessed as real property may
not exceed one-half of assess a!e of the ormanufacturedhome.
Signature ofAuditor Date signe ed d onihfday, at')
tJ I Cl
DISTRIBUTION:Original-CountyAuddor,File-Stamped Copy-Taxpayer
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