HomeMy WebLinkAboutHomestead_Lee (4) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
'` ` '=�,� STANDARD!SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R17/1-16) HC10 Zn?AD
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Prescribedby the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 61.1-12-37.
CERTIFICATION STATEMENT
I(We) '®be{ t.0 . certify that 1(we)occupied as my(our)principal
place of residence or am(are)buying the 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*nature). I(We):
gown. 0 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.
CLAIMANT'S INFORMATION
Name of claimant(legal name) Telephone number of claimant
1Zolot-it tee 812) 7-8i--260,.
sodetSecurity�number otdaimant(lastrivedlgifs) Driver's lcenseIldentilcalion/Other number of claimant(last fiedigits) issuing State
9 /Li/t.3 OI 1(Applo eppJ rd does not have a social secuitynumber.) on,A .
Name of claimants spouse(legal name) Z
Social Security number of claimant's spouse(last live digits) Driver's license I Identification l Otirer number of claimant's spouse(fast live digits) 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)
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Parcel number Legal desrripfion Is a perry in question:
Real property ❑Anmrallyassessed mobile home(IC 6-1.1-7)
If any po n of the residential structure or the land not exceeding cps(1)acre that immediately surrarm s that structure is used to produce income,describe the use and portion
of the pro utilized ha produce income.
2b -- \y--\$-lok-00 o . 227 00 9-
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township is claimant va ' g a homestead?
❑ Yes No
Signature y --' -nt/
I hereby certify the above statements are true,correct,and complete.
Address of contact(numberand street:city,state,and ZIP code) Address•'* r—homestead, (number
--,city,bide,and ZIP code)
• , —l511.— UR 66 0 .
ASSESSOR USE ONLY ASSESSED VALI_F i HOMES cAD V ALL,` I NON-RESICCATIAL
_ VALUE
Land not exceeding one(1)acre Immediately r
surrounding residential improvements (1) s 4/ 1 .
Qther land (2) ._ xr.. .
Total land(line d plus line 2) (3) 1 U t�l� 5 2n7
Q
Residential improvements or Dwelling (4) tD
annually assessed mobile/ i
manufactured home Garage (5) el ..
Other improvements (6)
Total improvements(line 4 through line 6) (I)
Total value(line 3 phs line 7) (8)
I hereby certify the above is true,correct, Signature of Asse 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 1C 6-1.1-12 fo 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.
Signature of Auditor Date signed(month,clay,year)
M S•S01%A g. ,. 20 20
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DISTRIBUllON:Original-CourdyAudtor,File-Stamped Copy-Taxpayer
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