Homestead_Kell Harper CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,.�.;:� FORM
STANDARD/SUPPLEMENTAL DEDUCTION �0��
,,r State Form 5473(R17/1-16) HC10 •
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side forfifing instructions.
NOTE Telephone,Social Security,driver's license,state identfication and federal identification numbers are confidential under IC 6-1.1-12-37.
� 1 yC�ERTIFICATION STATEMENT
• I t(We) 1 f�MI iT' .4 certify that I(we)occupied as my(our)principal
place•— idence or am(are)buying the fo owing,escribed 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)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.
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recordeF'LED Record number Page
PROPERTY DESCRIPTION
County iblaR 1 7 2020 Taxing disbict(city,town,township) •
Parcel number Legal description Is the property in question:
❑iReat property ❑Annually assessed mobile home(lC 6-1.1-7)
If any portion of the residential stmduurpoiei NI prry (1)A p1 tely surrounds that structure is used to produce Income,describe the use and portion
of the property utilized to produce in
z6 - . 1• '
�S - \ —.
` 0G0Z: _00 ,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
0 Yes. ,No '
igne f aimant
I hereby certify the above statements are true,correct and completes
Address of contact(numberend street city,state,end ZIP code) Address of vacated homestead,if any numbere end ZIP age)
2 6. %I 41 , 1
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL •
VALUE
Land not exceeding one(1)acre Immediately
surrounding residential improvements (1) , ....
Other land (2) s -
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements (6) '
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (6)
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(manta,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 ear o 0%of the assessed value of the homestead or$45.000.
Notwithstanding any other p• , e sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real p•••-' •rto a manufa +red home that is not assessed as real property may
not exceed one-ha9(1/2)of lb:-- - edvalu- - obiieho rman red home.
Signature of Auditor �� Date ed month,da year)
k • ( Oil-3-- 2r920
DISTRIBUTION:Original-CountyAudAor,File-Stamped Copy-Taxpayer
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