Homestead_Fisher (2) ;T.r CLAIM FOR HOMESTEAD PROPERTY TAX FORMYEAR
0 STANDARD/SUPPLEMENTAL DEDUCTION
-:4,`� State Form 5473(R17/1-16) H010
Prescribed by the Departmental Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE Telephone,Social Security,driver's license,state identification and federalldentificafon numbers are confidential under IC 6-1.1-12--.t -
1� CERTIFICATION STATEMENT
• ' I(We) I 1. 1' 1 % i tit - certify that I(we)occupied as m '• r)
place of residence or am(are)buying 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). 1(Wq O,/ O 4 2019
Own. ❑ Am(are)buying under recorded contract �V V
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 resid •
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. •. •
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
_Parcel number Legal description Is the property in question:
0 Real property ❑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.
26 I1r122 'ooO2 2 B. --007-
PROPERTY OVVNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead? I-6 4 ,Ir011
0 Yes 0 No
X
Siare ofclaimant /�'� \ (/+1I hereby certify the above statements are true,correct,and comple . l Si-) b ( - dGAddress of contact(numberendsheetdty,state,andZIPcode) of vacatedhomeslead"J' 'y(number dsb2e,dry; i'a= ar•ZIP•'e) t410- 'V\
I .�,..� - Z. : o r f•,li . 1.j . 1 pr11�y.12^
•
ASSESSOR USE ONLY ASSESSED VALUE f HOMESTEAD VALUE NON-RE IDENTIALVALU
� 9�1 W
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements
Other land (2) ..,, ...i.
Total land(line I plus line 2) (3)
s
Residential improvements or Dwelling (4) +
annually assessed mobile I h
manufactured home Garage (5)
Other improvements (6) .. . S '• -
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 tlay,)ear)
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.
Notwithsta ding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is no E es •as real property or to a manufactured home that is not assessed as real property may
not exce-•one- atf(112)oft e a essed val(,1j5-; :)
emobile home or manufactured home.
Signature- • . Date signe (�m�o(nth, ay,
teabt
DISTRIBUTION:Original-CountyAuddor,File-Stamped Copy-Taxpayer
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