Homestead_Boyken CLAIM FOR HOMESTEAD PROPERTY TAX FORMYEAR
'' STANDARD/SUPPLEMENTAL DEDUCTION
3,r HOW� =�-mq,r State Form 5473(R17/1-16) 2C71,-°
•
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing insbuctions.
NOTE:Telephone,Social Security,driver's license,state identification and federal idenb7cation numbers are confidential under IC 6-1.1-12-37.
,, CERTIFICATION STATEMENT
I(We)UP m IAL 1 J • certify that I(we)occupied as my(our)principal
place of residence or am(are)buying tbb 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):
Xwn. El 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.
)
CONTRAC RECC-RDE:') "
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded JAN L. 9 2020 Record number Page
PROPERTY DESCRIPTION
County Township T=.•
is • -.v4 hrp)
GIEJ�ON COUNTY Al mITOR
-
Parcel number Legal description Is the property in question: -
0 Rea/properly 0 • uarlyassessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceedng (1)acre that immediately surrounds that structure is used to•r.••uce income,describe the use and portion
of the property utilized to produce income.
1 \ -12 142-00 . 0y - 028 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes D
ASignature o
I hereby certify the above statements are true,correct,and complete.
Address of contact(numberend sheet city state,and ZIP code) Address of vacated homestead,if (number and street,city,state,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1) l
surrounding residential improvements
Other land (2) - °.; • .-.s
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home age (5) - -. _.
Other improvements (6)
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 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:1•vi • the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as •orto a manufactured home that is not assessed as real property may
(VP not exceed one-half h=.• essed value of the mobile home or manufactured home.
Signature of Auditor Date signed month,day,year).
/� P � 29 ,202G
DISTRIBUTION:Original-CountyAudltor,File-Stamped Copy-Taxpayer
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