Homestead_Zheng e, ,,r CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,;I,� STANDARD!SUPPLEMENTAL DEDUCTION FORM
-s. 2egf' StateFonn5473(R17/1-16) HCI4 20`q
Prescribed
by the OepairtrneMof Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential wider IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) e_ Z certify that I(we)occupied as my(our)principal
place of = idence or am(are)buying Ilowirtg 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):
Own. ❑ Am(are)buying under recorded contract.
m(are)entitled to occupy as a tenant stockholder of a cooperative housing corporation.
El 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.
;
CONTRACT ReCORDED
If buying on contract,Fee Simple owner's rain:
NOV 122019
Recorder's office where contract is record Record number Page
•
if Li
PROPFR1't 1.PSCRIPTION
coo _ T NCOUNTY AT� drdcty town, • flip)
..c.t,
Pa r Legal description Isih=�•erty in question:
'4'Real property 0 Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the-:,d not exceeding one(1)ace that immediately s r••tin s t _ structure is used to produce income,describe the use and portion
of the property utilized to produce income.
26—\2- 01 —�402 000. 131 -o2.1S'
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
0 Yes ❑ No '
Signature of claimant
I hereby certify the above statements are true,correct,and complete. _'WQ/�_A11-ee„ ,
Address of contact(numberand sheet city state,and ZIP code) A Tess of vacated horn--•--•,if a u •- and sheet,dfy,state and VP- e)
. A St •' Yl-Dh—
ASSESSOR USE ONLY 1 ASSESSED VALUE i HOMESTEAD VALUE i NOf r R SIDENTIAL / ^
Land not exceeding one(1)acre Immediately , _ (�1 •J}�p
surrounding residential improvements (1)
Other land (2) _., ' .m
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements (6) =
Total improvements(line 4 through line 6) (7)
Total value(tine 3 pits line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature ofAudlitor Date signed(month,day,year)
I
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 1C 6-1.1-12 to a mobile home $
that is not assessed as real property orfoa manufactured ho ' not assessed as real property may
not exceed one-haS(1/2)of fhe assessed value of the de home or anufaclu ed home.
Signature of Auditor - Date signed(month,day,year)
-S' SrrnA'h .
DISTRIBUTION:Original-County Auditor,File•Sfamped Copy-Taxpayer
Page 1 of 2