Homestead_Reed T, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
. STANDARD/SUPPLEMENTAL DEDUCTION FORM
\ - ,,.1" State Form 5473(R17/1-16) HOIO
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side fork-ling insbuctions.
NOTE Telephone,Social Security,driver's license,state Identification and federal identification numbers are confidential under IC 6-1.1-12-37.
1 CERTIFICATION STATEMENT.t
I(We) % Ch Q.r-f{ •�e.[cd 4•0-4X cG.t; 1=1 % certify that I(we)occupied as my(our)principal
place of residence 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):
IB Own. ❑ Am(are)buying under recorded contract.
❑ Am(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
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township) •
Parcel number Legal ascription Is the prop in question:
eal 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 surrounds that structure is used to produce income,describe the use and portion
of the properly utilized to produce income.
0 —�O — (�r= 1 co - oc0.P-{7
I - 00 fl
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Iles 0No '
" ature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number sheet city;state,and ZIP code) Address of vacated homestead,if (number and street,city,state,and ZIP code)
6 °) n� • piarj�.. (i, ZotOa. OOs . ,�1 -- tQQd0-1.1 .
ASSESSOR USE ONLY ASSESSED VALUE f HOMESTEAD VALUE NON ESIIDENTIAL
VALU
Land not exceeding one(1)acre Immediately (1) ktnns-1-.:g4;'.-W?'..'-,{ b
y
surrounding residential improvements
Other land (2)
--v-i
Total land(line 4 plus line 2) (3) (�
Residential improvements or Dwelling (4) + ,,:- ,'.
annually assessed mobile 1
manufactured home Garage (5) 1' i
Other improvements (6) = ,,.
i
Total improvements(line 4 through line 6) (7) UN�� AUp�TOR
Total value(line 3pls line 7) (6) G,gN C'SO °
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 properly orto a manufactured home that is not assessed as real properly may .
not exceed one-half(f/2)of the a ed value of the mobile home or manufactured home.
Sig of Auditor J Date signed(month,day,year)
4
c3 3�ta—aO�.
DISTRIBUTION:Original-CountyAuddor,File-Stamped Copy-Taxpayer
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