Homestead_Knapp (2) a "ev CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
�; STANDARD I SUPPLEMENTAL DEDUCTION
8� )''. l+ State Form 5473(RIB/1-20) HC10
\'a ejO 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) ! ,t.... certify that I(we)occupied as my(our)principal -
place of reside c=or-m(are)buying the followtig klescribed real property under contract for which a Homestead Property Tax Standard
xf.uction is hereby claimed on the date this application is signed, (date of signature). I(We):
Own. 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.
O Am (are)the shareholder, partner, or member of the entity that owns the property.
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CONTRACT RECORDED
If buying on contract,Fee Simple owner's name — I
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 description Is t openly 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 surro ds t structure is used to produce income,describe the use and portion
of the property utilized to produce income.
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Yen J No
Signat.17 claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state,and ZIP code) este-d,if any(nu e e d •-- city,s. - and ZIP code)
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ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON- ESIDENTIAL
VAL
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 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 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 r•. •• sion,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed- •- perty or to a manufactured that is not assessed as real property may
not exceed one-half r o•he assessed value of the obile ho or manufactured home.
Signature of Auditor CV Date ' d(mont d,v,year)
ilANNIt‘lii 1/%•01.o0
DISTRIBUTION: Original-County Auditor,File-Stamped Copy- r
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