Homestead_Michel (3) CLAIM FOR HOMESTEAD PROPERTY TAX t)a�N YEAR
STANDARD/SUPPLEMENTAL DEDUCTION F OM
s� State Form 5473(R77/1-16) HCIO
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE Telephone,Social Security,driver's license,state identification and federalidentiiftcaffon numbers are confidential under1C 6-1.1-12-37.
CERTIFICATION STATEMENT '
l(W %ce
e) I • �' ' # Irtify that I(we). :: p- (o r)I;rin l p
place of residence or am(are)buying the following described real property under contract for which a Hom -'y d•,•rope.' ax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
ElOwn. CIAm(are)buying under recorded contract J U L 2 8 2020
❑ 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 .- - residen tru of
• ❑ Am(are)the shareholder, partner,or member of the entity that owns the property. `Luka210f171j j0
•
•
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxi 'et(city town,township)
Parcel number Legal d •�
'•ption �c0_ , _ �.._[/J- Is the p�pedy in question:
`/�Z� t!�Irt`l{ro 1R+�(R�property ❑Annually assessed mobile home(IC 61.1-7)
If any portion of the residential structure or the Ian 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.
a(o-. 14- 35 - hod - oo .1 .(; 1S -o��
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑No
Signal tuLeofdaimant nw -%` _
I hereby the above statements are true,correct,and complete. `
/J/� // /'i,//�
Address of contact(number and street city,state,and ZIP code) Address of vacated homestead,if any(number and street,city,state,and ZIP code)
■I • 4i-+"•P Dal! 34G LLIDS+a +; I /76, • ,
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements
Other land (2) r
Total land(line 4 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) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day;year)
and complete.
Verifying action-Signature of Auditor Data signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE.
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstandng 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 property or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signahueo//� Date signed(moMh,day,year)
w I/
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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