Homestead_Biel (2) CLAIM FOR HOMESTEAD PROPERTY TAX ham' r
a�Y It STANDARD/SUPPLEMENTAL DEDUCTION FORM � �J
4 + State Form 5473(R18/1-20) HC10 �'
''' i` Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. OFC ,,,,,e,
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37. •r ;r
�� CERTIFICATION STATEMENT p 00
I(We) �/1 ��7gM certify that I(we)occupied i . z •rinc'pal
place of residence or a/(are)buying the following described real property under contract for which a Homestead Property' rr�.:
Deduction is hereby cl-med on the date this application is signed, (date of signature). I .'74",
Own. ❑ Am(are)buying under recorded contract. `1 c00
rLJ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. T04)
❑ 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.
.: „
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
Cou' / Township Ta'g d (city, n,township)
Parcel number Le I es ption the property in question:
/Jaryy��L�� ����/ Real property E Annually assessed mobile home(IC 6-1.1-7)
If any portion t esidential structure or the la d not exceeding one(1)acre that imrtt&diatel surrounds that structure is used to produce income,describe the use and portion
of the property ei red to produce income.
c g../y'/-3O5(020•6702— 00.7�
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,county,and Township Is claimant vacatin a homestead?
----. ❑ Yes No
Signature o claimant
I hereby certify the above statements are true,correct,and complete. yy`` /Ry
Address of contact(number and street,city,state,and ZIP code) Address o vacated estead,��(number and street,city,state,and ZIP code)
a?6.3 i�,GdC4 S
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
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 . ,,f the deductions provided in IC 6-1.1-12 to a mobile home $
that is not.as, d as real property o -anufactured home that is not assessed as real property may
not excee.• If(1/2)of the ass: alue of the mobile home or manufactured home.
Signature • Dale signed(m h,da year)
00(
DISTRIBUTION: Original- aunty Auditor,File-Sta/ps¢¢opy-Taxpayer
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