Homestead_Speer CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
�yam__-� STANDARD/SUPPLEMENTAL DEDUCTION FORM _]��
.. h State Form 5473(R17 t 1-18) HCI O LL./(.,.
5 fa. Prescribed by the Depadrnentof Local Government Finance
INSTRUCTIONS:See reverse side forfiing instructions.
NOTE:Telephone,Soda!Security,driver's license,state identification and federal identfrcafion numbers are confidential under IC 64.1-12-37.
(� p CERTIFICATION STATEMENT
1/r •• 1(We) eon� T S e certify that I(we)occupied as my(our)principal
place of residence or am(are)buying a 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. ❑ Am(are)baying 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.
Social Security number of claimant's spouse(fast five digits) Driver's license I Identification l Other number of claimants spouse(fast five dolts) 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 Taxing district(city,town,township)
Parcel number Legal description Is the property in question:
❑Real property 0 Annuallya,-vessed 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 property utilized to produce income,
2L
- I\-3 2- 1 co-coo •q Lk o -021
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is • nt vacating a homestead?
Yes ❑ No '
renature da'mant 1
r -1, .- r"9 th- _,g : : T
and complete.Fd
Ad• of vacated ames(�d•if mberandstreetdry state•andziPcode)
a f
U1/4) ,S�5 )n....
ASSESSOR USE ONLY I ASSESSED VALUE i HOMESTEAD VALUE I 6 A
NOP RESIDENTIAL ��� r,
VALUE
Lan • exceeding one(1)acre Immediately
surrounding residential' .rovenfents (1)
Other d • (2)
Tote �q fn D
r��� C,OU A� 1T0►� (3)
G ietamenual improvements or Dwelling (4) ▪ ., _
annually assessed mobile!
manufactured home Garage (5) ▪ :
.. i
Other improvements (6) ;,,i r !.;y: x,. _
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus fine 7) (8)
I hereby certify the above is true,correct, Signature ofAscessor 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, he deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property• .dared home that is not assessed as real property may
not exceed one-half(1/2)of the asse a'of them••7,home orm home.
Signature of Auditor `I Date sign Ai •rifh d , T
77
DISTRIBUTION:Original Auddor,Fil= ter` Copy Taxpayer V
9 �y P P
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