Homestead_Young (2) r` CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
To STANDARD/SUPPLEMENTAL DEDUCTION OR ZoZ9
"r� State Form 5473(R17/1-16) HOIO
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side forfiing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers ate confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We),SQS y0. ) h)V/11 certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the TWoiving 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):
4Own. ❑ Am(are)buying under recorded contract
Am(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 owners name
Recorder's office where contract isFILE1-_)
Record number Page
PROPERTY DESCRIPTION
County VITS!;. ,n,nc�1 Taxingdistrict(city,town,township)
\.5o A pciI ►l l _
Parcel number descripfion Is e p pert in question:
��..,,
Real property 0 Annually assessed mobile home QC 6-1.1-7)
If any portion of the residenn S'trii�pp�O Etilti MpqmatiLacreimmediately surro s at structure is used to produce income,describe the use and portion
of the property utilized to produce income. /r-i1 UU LVl rr R
2.6 —20-OZ"1°1 — ooa. . o11/4i2 -0O3 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant v ' g a homestead?
0 Yes No •
I hereby certify the above statements are true,correct,and complete.X Signature of claimant
of Address of contact(numberand abr;e4 city,state,and ZIP code) ress - ,if any(nu rand city,state,and ZIP code)
to ug i'rlal„ S`.N,shalt, an-1.6 s 3
ASSESSOR USE ONLY I ASSESSED VALUE 1 HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1) f
surrounding residential improvements
Other land (2) 4-;
•,§k
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) s
annually assessed mobile 1
manufactured home Garage (5) 3" _ -,
.,
Other improvements (6) ,„i -., ..,.
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus 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 L- - •',So of e assn<•sed value of the homestead or$45,000. •
Notwithstanding any other provi • m of e ded ctio;s provided i g-'1- to a mobile home $
that is not assessed as real pro•: •r to:m. ufactu-• h• e th.,' not assessed as properly may
not exceed one-half OM of the a, --•ed ;.eofthe t Ir' or manufactured home.
Signahue of Auditor 4114h, C % Date gned(mo ,day,year)
• C Sl2c52. •
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer /