HomeMy WebLinkAboutHomestead_Dyer (9) ` CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' ;,,e. STANDARD/SUPPLEMENTAL DEDUCTION FOB /v��
'� , . State Form 5473(R17/1-16) HCIO 2O` 1'
Prescribed by the Department of Loral Government Finance I
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential under1C 6-1.1-12-37.
p A CERTIFICATION STATEMENT
I(We) 0 1 v` certify that I(we)occupied as my(our)principal
place of residence or am are) ying the following described real property under contract for which a Homestead Property Tax Standard
i-. ction is hereby claimed on the date this application is signed, (date of signature). I(We):
A 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
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County I Township Taxing district(city,town,township)
Parcel number Legal description Is a operty in question:
Real property 0 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 surro ds t structure is used -•y ,de Meuse •portion
of the property utilized to produce income.
.. l k
6 . -11 �- 12-Ir'03 -(Q00.
°CD o
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Yes.0 o ' ,
signat of imant
I hereby certify the above statements are true,correct and complete. ��ON COUNTY AUDITOR
Address of contact(numberand street city,stale,and ZIP code) ress of omestead,if a,(nu .•- and street,city • •ZIP code)
10gC� • woo . -� � 1 ()11
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
iii VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements
Other land (2)
•
a
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile 1
manufactured home Garage (5) _ ` r
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (6)
I hereby certify the above is true,correct, Signature ofM'.essor 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 oth the sum of the deductions provided in 1C 6-1.1-12 to a mobile home $
that is not assessed as -- or to a manufactured home that is not assessed as real property may
not exceed one-half(1 • ,ssessed value of the mobile home or manufactured home.
Signature of Auditor '6, Date signed(month,day,year)
l '----.9 J\0
DISTRIBUTLON:Original-CountyAuddo,File-Stamped Copy-Taxpayer
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