Homestead_Helmling (3)
��= STANDARD/SUPPLEMENTAL DEDUCTION �
1 ;E.�' State Form 5473(R18/1-20) HC10
>�-"'
�a'�" 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 federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) ~ Id 1 • a ' ( In certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following des ibe real property under contract for which a Homestead Property Tax Standard
XOwn
ction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ 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.
: .2i '--P"" ,_ - =
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)
sow • 0
Parcel numbe Legal description Is a operty in question:
Real property ❑Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sun nds th t structure is used to produce income,describe the use and portion
of the property utilized to produce income.
P ^ 16 _30 WO -9•oz -11 -102,_. ,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township
Is•,al ant vacating a homestead?
(.2.-Cil().— -1°Ck..- 26-.3f) 5 V.ri s `Si n6ture• claiman ❑Yes No
i yy/.....," ..../
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state,and ZIP code) ,(-coy) G
Add: ,
f",ate tre homestead,if any(number and at,city,state, •':
Y, �
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-VALUENTIAL
•Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land ( ) *1',
4
Total land(line 1 plus line 2) (3) , 'g_
•Residential improvements or Dwelling (4) hi
annually assessed mobile/ \4'
+ ��
manufactured home Garage (5) -; Q�0
�tti
Other improvements (6) , \�� t
Total improvements(line 4 through line 6) •) P� ' ���'Jo\�O
Total value (line 3 pits line 7) (8) • A*C�Q`
I hereby certify the above is true,correct, Sign.lure of Assessor ` t \ Date signed(month,day,year)
and complete. `G�
Verifying action-Signature of Auditor S�\ 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 p.•sion,te of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real• •. manufactured ome hat is not assessed_as real property may
not exceed one-half(1/2)of alue of the m•••ile / e or m actured horlr e. r
Signature of Auditor ,� Date siS m irai ,(da^y,y i
DISTRIBUTION: Original-County• ditor,"le-tamped Copy-Taxpayer
e1of2 •
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