Homestead_Cox CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
�.;:�,elji.ifk� STANDARD/SUPPLEMENTAL DEDUCTION FORM
+ State Forrn 5473(R17/1-18) ZO n
Presaibedby the Department of Local Government Finance •
INSTRUCTIONS:See reverse side forfiing instructions.
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
(We) 0 •7 . • 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
Ded ction 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.
❑ 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.
PROPERTY DESCRIPTION
County C_ A Township ! Taxing district(city,town,township)
qx J-�1
•
Parcel rurWr Legal description (Is th' •roperty in question:
ri _eat property El 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 sumo•ds the; aura is used to produce income,desaibe the use and portion
of the property utilized to produce income.
e2r-6 ' 'C tA. '-_ 1i --3 0� � 0
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑No '
Sign:,r/•fdaimant
I hereby certify the above statements are true,correct,and complete. //
Address of contact(numberand street city,state,and ZIP code) 1••• of .,•-• -•ho i-- -•,if any r sfreat -_,a •_-code
ASSESSOR USE ONLY f ASSESSED VALUE M HOMESTEAD VALUE 1 NON REALUEN+IAL ``n
Land not exceeding one(1)acre immediately •�, `Il 1
surrounding residential improvements (1) , r V_1
Other land (2) •_b t ` L et/6
Total land(final plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile I
manufactured home Garage (5)
Other improvements (6) _V' - °', r " ' , *t^
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 Ohre homestead or$45,000.
Notwithstanding any oth. • sio• he sum of the deductions provided in 1C 6-1.1-12 to a mobile home $
that is not assessed as " rto a manufactured home that' ssessed as real property mayir
not exceed one-hall(1 ad value ofthe mobile or man red home.
Signature ofAudter A,,,A,'--Aik c.\�n D�some o ty,iar)
J �/1
DISTRIBUTION:Odginal'-Cc tli•dor,File-Stamped Copy-Taxpayer
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