Homestead_Shoultz ,----., CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a -5.0„< STANDARD/SUPPLEMENTAL DEDUCTION I FORM
�''� _ State Form 5473(R18/1-20)
HC1 0
�` Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. s t
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confident a .'detlC 1.1-12 :- IgiE Ai
CERTIFICATION STATEMENT
I(We) .i.A..:r- rL SJiiil • ce r . (we)occupied as my(our)principal
place of residence or am(are)buying the following descr':ed real prop,rty u (er contract for which a r Homea ripe$ty ti,i andard
Deduction is hereby claimed on the date this application is signed, (date o signs ure). �r+e:
❑ 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 ofdlp4alifi typo I e�pglr�st0P,
0 Am (are)the shareholder, partner, or member of the entity that owns the property. li U Ur' 11U I
.. - - !
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing 'tricl(city,town,township) 1
Parcel number gal description 7 .....2. — / Is the property in question:
��``�r A .b ,- eel 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 .43 — el7 - too - 0o0, Y75 - Do6
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Yes 0 No
Signature o aimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state,and ZIP code)2750 S, $S0 G 046L-4 yr c Address of vacat omestead,if a y(number and street,city,state,and ZIP code)
ASSESSOR USE ONLY 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) .
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 other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of uditar + / Date signed(month,day,year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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