Homestead_Rudolph (2) <^•-., CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
°4_'`rt,��. STANDARD I SUPPLEMENTAL DEDUCTION FORM
p'.)I, ``'�• State Form 5473 R18/1-20) HC10 �ZQ
%" 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
described real properV unslerco ract fforrwhich a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, I I' 1-1 (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.
`• ;
)
CONTRACT RECORDED
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)
Parcel numb �� Legal description U Is t e roperty in question:
��v� 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 surroun s th t structure is used to produce income,describe the use and portion
of the property utilized to produce income.
26— . L.-18 -sof -- 000. 21 -°0- -
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant va ti g a homestead?
❑ Yes No
x Sig of claimant
I hereby certify the above statements are true,correct,and complete./
AL
Address of contact(number and street,city,state,and ZIP cod) Address of elect homestead,if any(number and street,city,state,and ZIP code)
10 t& WI- St do. t Ci --311-44- 6 0
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
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) ''0..'"
annually assessed mobile/ Al
^ (`
manufactured home Garage (5) ``'' tor°
Other improvements (6) NO V
i
Total improvements(line 4 through line 6) (7) it O\ oR
(lira,' PV Total value (line 3 plts line 7) (5) (�i
I hereby certify the above is true,correct, Signature of Assessor .t._}yl CO��� Date signed(month,day,year)
and complete. ON
Verifying acficn-Signature of Auditor 01;35 Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of th-assessed value of the homestead or$45,000.
Notwithstanding any other provision,the- 9eductions provided in IC 6-1.1-12 to a ome $
that is not assessed as real property or to- tured home that is not assessed al groped ay
not exceed one-half(1/2)of the assessed • -.f the mobile ho r manufactu home.
Signature of Auditor ` Date signed(month,day,year)
li C.J 7 << 10�/� 1-0 1., .
DISTRIBUTION: Original-County Auditor,File-Ste —dCopy-Taxpayer
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