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Homestead_Georges (8) p CLAIM FOR HOMESTEAD PROPERTY TAX YEAR ,,qq STANDARD/SUPPLEMENTAL DEDUCTION FORM A ^ ,,, nn . Cl .� State Form 5473(R18/1-20) HC10 - H'� °'- �i-. ,'". 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) • U\ certify that I(we)occupied as my(our)principal place of residence or am(are)bu 'ng the fo to ing described real pro rty�rlite ontract for which a Homestead Property Tax Standard De ction is hereby claimed on a W date this plication is signed, s �l (date of signature). I(We): Own. 0 Am(are)buying under recorded contract. m(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. O 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. CLAIMANT'S INFORMATION Name of claim (/ al name) Telephone number of claimant Social Security number of claima last five digits) Driver's license I Identification I Other number of claimant(last five digts) Issuing State �) (� (Applicable onlyi(.a lica its not have a social security number.) 3NO Name of claimant s spouse(legal name) Social Security number of 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.) CONTRACT RECORDED If buying on contract,Fee Simple owner's name Recorder's office where contract is recorded Record number Page PROPERTY DESCRIPTION County 30 ^ Township Taxing district(city,town,township) © 0 \ , Parcel numtr ' I Legal description Is the petty in question: • eat 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 surrou s that tructure is used to produce income,describe the use and portion of the property utilized to produce income. �G --?� �-Z ' _ , Oo , 69 _oO \ PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is i nt vacating a homestead? Yes ❑ No Si'natu claim nl 24 I hereby certify the above statements are true,correct,and complete. Illii/!,---- i. C. J Address of contact(number and street,city, e,anj1<) P co ) ' dress o vacated homestead,if nyy(number and street,city,state,and ZIP code) `J EgVWLt, o 'r��a�6�1�., • sal.5� e :, . J')-- 1-19-6 iiis'' NON-RESIDENTIAL ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I VALUE O and.r.t exceeding one(1)acre immediately CV '-•r3ou ding residential improvements - (1) O r SL lasil CV 4'e•r��and (2) Nil, end(line 1 plus line 2) (3) z,O'-.zs, U 'R ice dial improvements or Dwelling (4) , L1 1 a u{af y assessed mobile/ 0 c.,.. ri uractured home Garage (5) t` ` fillIal Othemprovements (6) Totanprovements(line 4 through line 6) (7) U 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 p..visii l lf e sum of the deducti ' din IC 6-1.1-12 to a mobile home $ that is not assessed as re. pro. y or to a m n facture ome that is of assessed as real property may not exceed one-half(1/2)of thsP ssessed val f the obile home or anufactured home. Signature of Auditor Date signed(month,day,year) A 2 i- W1o . DISTRIBUTION:Original-• r,FileStamped Copy-Tax Page 1 of 2 ' _... _ --..