Homestead_Ziliak (8) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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STANDARD/SUPPLEMENTAL DEDUCTION FORM
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+, ��r State Form 5473(R17!1-16) HOW
Prescribed by the Depattmentof Local Government Finance
INSTRUCTIONS:See reverse side for Mg instructions.
NOTE:Telephone,Soda!Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICAl1ON STATEMENT
I(We) 7CI s h. iu(k -1 ,• certify that I(we)occupied as my(our)principal
place of reside'ice ora (are b ing the following described real property under contract for which a Homestead Property Tax Standard
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Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
wn. ❑ Am(are)buyingunder recordedcoct.m(are)entitled to occupy as a tenant stockholder of a cooperative housing corporation.
0 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 p A'
Recorder's office where contract is recorded J HI u 7020 Record number Page
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PROPERTY DESCRIPTION
County Township �3 p T-.,Rh""'',7— , tg•c iu, !
Parcel number Legal description Is the property 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 surroundsis used
that structure to produce income,describe the use and portion
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of the property utilized to produce income.
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(2)0
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑No
Signature of claimant ♦ ,
I hereby certify the above statements are true,correct,and complete.
Address of contact(numberand sheet,city,state,and ZIP code) Address te�,if a mber and street,city,stale,and ZIP code)
3ont c S 2 6
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately r.:
surrounding residential improvements (1) ,. . i-._ ._ '',
Other land (2) 4.
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5) . '-',.} -
Othar improvements (6) s ,, ,' '
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (S)
I hereby certify the above is true,correct, Signature ofAssessor Date signed(month,day,year)
and complete.
Verifying action-Signature ofAudrtor 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' - sion,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed. -..operty or to a manufactured home that is not assessed as real property may
not exceed one-half • ,the assess value of th obile ho rmanufactured home.
Signature of Auditor ' Date signed(month,day,year)
DISTRIBUTION:Original- untyAuditor,File-Stamped Copy- axpayel'
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