Homestead_Schmett ,. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
HCIO C.Sp'�.
� sYaq; State Form 5473(R17/1-16) 1
Prescribed
by the t)epartrireMol Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOW Telephone,Social Security,driver's license,state idenffication and federal identificalion numbers are confidential under IC 6-1.1-12-37. I
CERTIFICATION STATEMENT
I(We) ► V certify that I(we)occupied as my(our)principal
place of residence o am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereb claimed on the date this application is signed, (date of signature). I(We):
‘g Own. ❑ Am(are)buying under recorded contract
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 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
If buying on contract,Fee Simple owner's name - ' r - Y
Recorder's office where contract is recorded Record number Page
t I I . I '
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township) •
Parcel number Legal description r 7/ +`f
GIBBON C O U i al,I .roeedvin Question' .
property ❑Annually assessed mobile borne(/C 6-i.1-7)
It 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.
-�.1 QD..._-O 3 O -'O2'1 .
.,•,. .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,Cry,and Township Is claimant vacating a homestead?
0 Yes 0 No
S" a of cla nt
I hereby certify the above statements are true,correct,and complete.
Address of contact(numberand dieet oty,state,and ZIP code) A of vacs om ,if-u(number and street city,state,a •ZIP code)
3-30 c7 Lam' k CANC(1 I
ASSESSOR USE ONLY i ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately i.
surrounding residential improvements (1)
Other land (2) `
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) • k.= z' a+
annually assessed mobile/
manufactured home Garage (5) ` -.•
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (8)
1 hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Veifyirig action-Signature ofAudtor ' Date signed(month,day,year)
1
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 property may
not exceed one-half(1/2)of the assessed value of the mobile ho manufactured home.
Signature ofAudlare," c-- 1.) Date l t e (month,day, •
i-- ti
DISTRIBUTION:Original-CountyAuddor,File-Stamped Copy-Taxpayer
Page 1 of 2