Homestead_Colbert CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
'�'' ; STANDARD/SUPPLEMENTAL DEDUCTION FORM "
State Form 5473(R17/1-16)
Presaibed by rite Depasbnentof Local Government Finance HC70 2tZ0
INSTRUCTIONS:See reverse side for filing instructions.
NOTE Telephone,Social Security,driver's license,state idenffication and federal ident ca&on numbers are confidential underlC 6-1.1-12-37.
CERTIFICATION STATEMENT
r Ile,•
I(We) 1nI Q, f. 1 • • certify that I(we)occupied as my(our)principal
place of residence• .m(-e +eying the following described real property under contract for which a Homestead Property Tax Standard kDuction is hereby claimed on the date this application is signed, (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-
❑ 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
Jif buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County To .•- ' Taxing district(ex town,township)
.� ) 7 No� .
Parcel number Legal description Is the gfoperty in question:
Real property ❑Annually assessed mobile home(1C 6-1.1-7)
If any portion of the ntial 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 ce income.
18. -35-- 1o0 -.0OZ . .9"k -ozkA .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
0 Yes 0 No
Sign {,a of claimant ;W A s CfQPJ±-
Address I hereby certify the above stafemenis are true,correct,and complete. 'of contact(numberend sib city,state,and ZiPcode) Add —• ----led h et--•,if any(number and stre city,state,and ZIP code)
. / 1 9-5-- ,s 0vi 1\ - - 11 LI t 6 6
ASSESSOR USE ONLY ; ASSESSED VALUE HOMESTEAD VA!.PE NON-RE IIDENTIAL
VALU
Land not exceeding one(1)acre Immediately (1) , P. a`
surrounding residential improvements s.
-
Other land (2) -a
Total land(line 1 plus rine 2) (3) JUN
Il1A I 1 2
7'7 2020
Residential improvements or Dwelling (4) ,
annually assessed mobile/ i
manufactured home Garage (5) r
Other improvements (6) % 1
Total improvements(line 4 through line 6) (7) •
Total value(fine 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(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's not assessed as real properly orto a manufactured home that is not assessed as real property may
not exceed one-hatr )of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,
•
y,year)
mi � � (0• ‘ •Lo20 .
DISTRIBUTION:Original-CountyAuddor,File-Stamped Copy-Taxpayer- - '
Page 1 of 2