Homestead_Wilkison (14) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,� STANDARD/SUPPLEMENTAL DEDUCTION �,.y�,�
- FORM
~ HOW ��.
i" State Form 5473(R17 J 1-16)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for Mg instmctions.
NOTE:Telephone,Social Security,driver's license,state identification and federal ideri67rcalion numbers are confidential underlC 6-1.1-12-37.
CERTIFICATION STATEMENT
If
I(We i Yee t/latj ry t impiN certify that I(we)occupied as my(our)principal
place of reslden. 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). I(We):
Own. 0 Am(are)buying under recorded contract
Am(are)entitled to occupy as atenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust or the right to occupy the,f under the terms of a qualified personal residence trust
0 Am(are)the shareholder, partner,or member•. e-i r th I • ii the property.
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office wham contract is recorded Record number Page
PROPERTY DESCRIPTION
County n ,S011\ Towns • 'pig , Taxing district(city,town,township)
•
Parcel number Legal description ' Is roperty in question:
'A Real property 0 Annually assessed mobile home(IC 64.l-7)
If any portion of the residential structure or the land not exceeding one(1)arts that immediately surro ds -t structure is used to produce income,desaibe the use and portion
of the property utilized to produce income.
2- 6 _ O-23 -`253$O.0 02 • H6 -00I .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
,n❑ Yes,❑ No- i ,
at re of claimant , • • // '' i
I hereby certify the above statements are true,correct,and campleteK 1�ru 1 ^ ^ ._
//\\ • y �lJ(1�+��I�V t
Address of contact(numberand atr4 city,state,and ZJPcode) ddress of vacated homestead,if any(number and street,city,state,and ZIP code)
g.5-b1 s gwE 0 - : cld on-t��-613 .
ASSESSOR USE ONLY i ASSESSED VALUE 1 HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately
surrounding residential improvements (1) -„ . i.
Other land (2)
Total land(final plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements . - . (6) .._,.jX $...,._...,.i`..,...<:
Total improvements(line 4 through line 6) (7)
Total value(line 3 pits line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor 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 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(112)of the assessed value ofthe mobile home ormenufaclured home.
Signature of ddor Date signed(month,day,yea,)
, Snnlill 2 .2) - 2 off?
DISTRIBUTION:Original-Courtly Audio,File-Stamped Copy-Taxpayer
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