HomeMy WebLinkAboutHomestead_White (23) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
'* STANDARD/SUPPLEMENTAL DEDUCTION FORM
\ - qr State Form 5473(R17/1-16)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confider), I ,. C,$f.1-12'- '
CERTIFICATION'STATEMENT
• I(We) ' a 0 ' certify that I(we)occupied as my(our)principal
place of resi•if ce or am(are)buying the following described real property under contract for which a Home-..• ,.•01i,=ia and
Deduction is hereby claimed on the date this application is signed, is I
(date -'•re.
A Own. 0 Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. •
[] Have a beneficial interest in the trust or the light to occupy the property under the temis of a quafifi
0 Am(are)the shareholder, partner,or member of the entity that owns the property. GI B S O CO U N U I'I O R
)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taring disiri.I,town,township)
Parcel number jj�ege description Is// the property in question:
T� l property El Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not excee one(1 /� 1rtea that immediately raid__srttllXthat structure is used to produce income,describe the use and portion
of the property utilised to produce
income,
gg62-/a. /$ - /4 3 . '73. 7 - v,.1 a .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
C] Yes 0 No •
r at::: ,I'mant
I hereby certify the above statements are true,correct,and complete.)(.y
/ /j
Address aF contact(n mberand digstale and ZIP code) Add vacafedhomestead,ifany(numberandstreet,city,atdie,andZIPcode)
ASSESSOR USE.ONLY i ASSESSED VALUE HOMESTEAD'VALUE NON-RESIDENTIAL
I VALUE
Land not exceeding one(1)acre Immediately '
' surrounding residential improvements (1) . . .,.
Other land (2) x_ : a
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4) r
annually assessed mobile/
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 ofAucitor Date signed(month,day,year)
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 orbs a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of door Date signed(month,day,year)
DISTRIBUTION:Original-CountyAuditor,Fil pad Copy-Taxpayer ' —12r1----.....-
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