Homestead_Vanoven (3) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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�� =xe�r State Form 5473(R17/1-16)
Prescribed by the Department of Local Government Finance •
INSTRUC770NS:See reverse side for him instructions.
NOTE Telephone,Social Security,driver's license,state idenfification and federalidenldreation numbers we confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) i v O A \lbilMM /1 certify that I(we)occupied as my(our)principal
place of residence or am(are)b .the following 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
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ e a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑
! Record number Page
FRCPEP:Pt DRS.F.IPTIO\
County \ Township Taxing district(cJty,town,township)
Parcel num , Legal description Is the property in question:
0 Real property 9 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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.6 - 12 ‘ - lot - 000 , LIV -D
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is ciafma 'vacating a homestead?
0 _.\❑ No
Signier claimant .00 ..
I hereby certify the above statements are true,correct,and complete. . , .
Address of contact(number and street try,state,and ZIP code) A••ress• vacated horn-•,:r•,if any(number and let,city,state,and ZIP code)
1I . S ® • . p ,—
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
Land not exceeding one(1)acre immediately •
surrounding residential improvements (1)
Other land (2) ,;a+k ,..-S
Total land(line 4 plus line 2) (3)
Residential improvements or Dwelling (4) t r
annually assessed mobile!
manufactured home Garage (b) 4''
i
Other improvements (6) .;,_'` ,:..
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (8)
I hereby certify the above is true,correct, Si nature 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 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 $ -
that is not assessed as al• ••- or to a manufactured home that is not assessed as real property may
not exceed one-haff 12 of -.eased v-ue• the mobile home nuta d home.
Signature of Auditor i Date signed(month,day,year)
DISTRIBUTION:Original- Auditor,File-Stamped Copy-Taxpayer )))
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