Homestead_Dewig r?d CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
. STANDARD!SUPPLEMENTAL DEDUCTION FORM
`" State Form 5473(R17/1-16) HCIO
Prescribed by the Depaitmentof Local Government Finance
INSTRUCTIONS:See reverse side for filing instructIons.
NOTE Telephone,Social Security,driver's license,state identification and federal Identification numbers am confidential underlC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) PierlIFIi O r certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real party under contract for whirls a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is sign , (date of signature). I(We):
❑ Own. ❑ 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.
CONTRACT RECORDED
If buying on contract Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(ce7y,town,township)
Panxlnumber Le descri on " s ^��^
t�9� P5 j/�/t d / is a property in question:
/��� / /7//d,/a 0;Real property ❑Annually assessed mobile home(1C 6-1.1-7)
If any portion of the residential structure or the land no ceeding one(1)acre that imm lately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce raceme.
a6 - / 1 - 31 - 3o` coo • 0707, _ oo 9
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township - Is claimant vacating a homestead?
0 Yes 0 No '
Signaler n(claimant
I hereby certify the above statements are true,correct;and complete. � V Y
Address of contact(numberand street city,state,and ZIP code)\/
7, Address of vacated homestead,if any.(number end street city state,and ZIP code)
2-I9 111\c,\ S' ' ri, k5It,AT N
ASSESSOR USE ONLY i ASSESSED VALUE ` HOMESTEAD VALUE NON- ESIIDENTIAL
VALU
Land not exceeding one(1)acre Immediately r.
surrounding residential improvements (1) :- __
Qther land (2) aa
Total land(line I plus line 2) (3)
Residential Improvements or Dwelling (4)
annually assessed mobile!
manufactured home Garage (5) ...
Other improvements (6) ,., ' , ,,.r°
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,yea!)
and complete.
Verifying action-Signature of Auditor Datesi• ed month day, =-
.m �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 fo a mobile home $ N O V 1 3 2019
that is not assessed as real properly or to a manufactured home that is not assessed as real property may
not exceed one-hat(1/2)of the assessed value of the mobile home or manufactured home.
Signs of Auditor /9......6.....„ Date signed(mo , ay,year)
GINS wtry fcoUITOR
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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