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<a-7 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a,g:._-v--; STANDARD/SUPPLEMENTAL DEDUCTION FORM
• �t State Form 5473(R18/1-20) HC10
rem- Prescribed by the Department of Local Government Finance
IC 6-1.1-12-37.
CERTIFICATION STATEMENT
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I(We) !I !Jl '' ) P••n cunhOfl Q Ck -rtify that I(we)occupied as my(our)principal
place of residence or am(are)buying folio Lug described real property und:f t•,ct for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date th :-s•-- . , (date of signature). I(We):
❑ 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.
Social Securi A•m•"�,;f claimant's spouse(last five digits) Driver's license/Identification/Other number of claimant's spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number.)
I\( - CONTRACT RECORDED
4T5 •n g contract;Fee Simple owner's name
V } Q�O
Rertoeere contractis -corded Record number Page
'.al _ •
PROPERTY DESCRIPTION
Co tj 1 "A'f`/ , ' Township Taxing district(city,town,township)
lllumber er Legal description Is the property in question:
01) 0 Real property 0 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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
26—\L —01— Li 0 3 -002 . 12R -018 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes o
ASigna r fclai ant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state,and ZIP code) Aji ress of vacated ho•- lead,,if any(number-And o
er n Ld street,ci state,and ZIP code)
(�('A� FJ Wes1
l " Y�1 NON-RESIDENTIAL
, J�` tl i-6 r "
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE VALUE
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/ „
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$45,00D.
Notwithstanding any other provision,the su of the eductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real p e or manuf tured home that is not assessed as real property may
not exceed one-half(1/2)oft ass ss d I e of e mobile home or manufactured home.
n ure of Audi r Date sl f(m th,d=y,�e}.1�/r)
(/to. ri 'nal- my Auditor,Fi - tamped Copy-Taxpayer Z
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