HomeMy WebLinkAboutHomestead_Conner CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
_ STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Fort 5473(R17/1-16) HOW
Presaibedby the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state idenfflcation and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICAl1ON:STATEMENT
1(We an at 7 re- certify that I(we)occupied as my(our)principal
place of residence or amp(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deducti is hereby claimed on the date this application is signed, (date of signature). I(We):
Own. 0 Am(are)buying under recorded c ontract
❑ 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 residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. -
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number of claimants spouse(fast live digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number.)
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 T ( district(city,town,township)
t65C(-- T'�f'- 1\ L 11
_Parcel number Legal description Is the p or
in question:
Real property 0 Arnuallyassessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately asnounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
C:)LO - _ a , - \ 0\ - L ' ., 0\Q-.) -0 `
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacatin = omestead?
0 Yes No
Sign ire o atmant
I hereby certify the above statements are true,correct,and complete. , g
de.,......,_
Address of contact(number-and street;d state,and ZIPcode) A of vacated homestead,if any.(number and street city,state,and ZIP code)
0_ : ls.-. 4.Q- I st. •r% . u —Q"--1 L.(1.-1(0 .
ASSESSOR USE ONLY j ASSESSED VALUE I HOMESTEAD VALUE i NON-RESIDENTIAL
Land not exceeding one(1)acre Immediately (1) -` ,' r'
surrounding residential improvements ��'Q r
Other land (2) .: ,m , ,, ,, l)'Al�n
Total land(line I plus fine 2) (3) 00 Ao58/�
Residential improvements or Dwelling (4) F
annually assessed mobile/ }�
manufactured home Garage (5) U �t� `
., -c .fi K- tf 9.. N
Other improvements (6) a
- Vr
Total improvements(line 4 through line 6) (7) x
Total value(line 3 plus line T) (8) •
Signature of Assessor Date signed(month,day, - a
I hereby certify the above is true,correct,
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%u 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 or to a manufactured home that is not assessed as real property may
not exceed one-half(1I2)of the assessed value of the mobile home or manufactured home.
Sign of Auditor Date signed(month,day,year)
If D . 1-its-- i&Oa° .
DISTRIBImON:Original-CountyAuddo,File-Stamped Copy-T' er
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