Homestead_Ziliak (15) •
.�� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-8 �� STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R18/1-20) HC10 2020
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) Jonathan D. & Laurie M.Ziliak certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property_ niter contract-f which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, �. =r31E7 (date of signature(We):
IZ Own. ❑ 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.
Recorders office where contract is recorded Record number Page
Fes_
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
4'•
Gibson Johnson
Parcel number Legal description Is the property in question: //''''�
26-22-14-300-000.994-024 PT SW 14 4 11 2.39 AC I7I Real property ❑ Annually assedv4 bbile home(IC 6-1.
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe`` C( tt iianti portion
of the property utilized to produce income. ��V%7�o
C/eS�N CO .4P71.4,/ .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township
Is claimant vacating a homes•:.. O
El Yes m R
Signature of da"••nLf', 3$
I hereby certify the above statements are true,correct,and complete. L j ,/ ' .y
407
Address of contact(number and street,city,state,and ZIP code) Ad•(ss of vacated homestead,if any(number and street,city,state,and ZIP code)
12620 S. Scottsdale Dr., Haubstadt, IN 47639
ASSESSOR USE ONLY '` I ASSESSED VALUE I HOMESTEAD VALUEVALU I NON- ESIDENTIAL
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2) •
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile I
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 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 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 asses ed value of the mobile home or manufactured home.
Sign ure of Auditor Date signed(month,day,year)
s_a- Itnr‘o ) (03D --C
DISTRIBUTION: Original Auditor,File-Stamped Copy-Taxpayer
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