Homestead_Taylor (2) r, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORM
� H010 MI)
a State Form 5473(R17/t-16)
Presaibedby the Department of Local Government Finance v
INSTRUCTIONS:See reverse side for filing insbuclions.
NOTE Telephone,Social Security,driver's license,state Identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
♦ t �'n
• I(We) • W l't. - • . • ' • certify that I(we)occupied as my(our)principal
place of resider am(are). ing the foil.L�'ng describe.4:I property under contract for which a Homestead Property Tax Standard
eduction is here claimed on the date this application is sign-., (date of signature). I(We):
Own. 0 Am(are)buying under recorded contract
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.
•
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
CCounty ,J Township Taxing district(city,town,township)
6;__ ,E3.sog
Parcel number Legal description I the p petty 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 s raid that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
2C — bl-A:2(A-3b 2 -cot) . 06/o --r21?
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
0 Yes ❑ No '
gma� fdaimrar .
I hereby certify the above statements are true,correct,and complete. ` ` l., /.)
Address of contact(numberandefree city,state,and ZIPcode) Add'lr�� vacated estead,ifany(number street,city,state,and ZIP coda)
ASSESSOR USE ONLY i ASSESSED VALUE k HOMESTEAD VALUE I NON-RE IIDENTIAL
VAL
Land not exceeding one(1)acre immediately 1
surrounding residential improvements
Other land (. IT
F .}., ` , R t .,
Total land(line 4 plus line 2) (3)
•
Residential improvements or Dwelling (4) ' FER 2 6 2020 +
annually assessed mobile) l4
manufactured home age (5)
Other improvements (6) ; ., ,?, .,. _,..,:,
Total improvements(line 4 through line 6)
0)13bON COUNTY AUDITOR
Total value(line 3 phs 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 Aucbtor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60°• . ,-assessed value of the homestead or$45,000.
Notwithstanding any o..41
•vi•the sum of the deductions. • in IC 6-1.1-12 to a mobile home $
that is not assesse•-s =- .ro, ,• or to a manufactured home th. is not assessed as real property may
not exceedone-h.t(1/2) th ---essedvs e the mobile home,rmanufactur-• ome.
Signature ofAudi,•, •k 4g11111111
Date signed(month,day,year)
'1-2 6- •'2-o20.
• a
D!STRISUTION:Origi . .., .t.._..
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