Mobile Home_Bennett .•:,7-24t., CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4' '.Q STANDARD/SUPPLEMENTAL DEDUCTION FORM
�" State Form 5473(R18/1-20) HC10
•
N --1 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) \CD/N til'n i • certify that I(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 signature). I(We):
Own. ❑ 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.
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
Is claimant vacating a homestead?
❑ Yes ❑ No
Sign- re of clamant
I hereby certify the above statements are true,correct,and complete. / � �
-� i r
Address of contact(number and street,city,state,and ZIP code) Add'of vacated o••- ead,if•any(number and street,city,stale, ZIP code) 11 '�7/•yp,
-'= .L A.
,f ■� NON-RESIDENTIAL
VALUE - 3L—G` ' vc -ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I VALUE
3
Land . -*ceedin q r'1 acre immediately . .
su •t-.in, esi.ent-. improvements (1)u -
Tot, and(line 1 It®It 2) . (3)
Residential e\ements or Dwel((�e" (4)
annually assessed mobile/ 1' �Q\.`
manufactured home • y Q` ►age (5)
Other improveme O ��J (6)
Total improve(m�}e �ine 4 through line 6) (7)
Total valur�y�ihe 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 r. 0 Lesser of 6 t%.f the assessed value of the homestead or 645,000.
Notw • g any WI,-r provisi•,�p the s of the seductions provided in/C 6-1.1-12 to a mobile home $
that is.. , sessed as -:I prop-- •7•r to;manufa.tured home that is not assessed as real property may
not exc:-i. e-ha •f the�it a ue oft'e :•ile home or manuf.:..•d home.
Signature•n • or Date n moot,d ar)
IP v-441
t)
DISTRIB• : Original-County Auditor,File .tamped Copy-Taxpayer
Page 1 of 2