Homestead_Nance (2) .4,--, .o .,,,. CLAIM FOR HOMESTEAD PROPERTY TAX ti
Al-, , . ,,,,,, ., 1 ,, D.'''
STANDARD/SUPPLEMENTAL DEDUCTION FORM a
l' State Form 5473(R18/1-20) HC10
0�•` Prescribed by the Department of Local Government Finance DECINSTRUCTIONS:See reverse side for filing instructions. EC 21 2020
NOTE:Telephone,Social Security,driver's icense,state identi - '.n and federa '.:.tification numbers are confidential under IC 6-1.1-12-37.
CERTIFIC.ATION STATEMENT
I(We) �I Irt1/ �r a / _ I ••. at I(we)occupied as my •,t r n �fi If
place of residence or am - e) a f•,lowing described real. •.e • nder co ract f rb7whii h a Homestea�.PI[��Q ��TTa CITY AU OR
Deductio ' hereby Clair ed on the this application' ed, 12? di ,aor 6)(date of slg3tAftle lI(We):
Own. • Am(are)buying undo recorded contract.
❑ Am(are) entitled to occupy as a t- -et-stoc..• :-r of a cooperative housing corporation.
D Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County " Township • Taxing district town,tow ship)
ited
Parcel number Legal description Is t)te pjbperty in question:
—
State,county, nd vmship Is ai nt vacating a homestead?
A/37 . s� r , /v �7(c,t)_ Yes ❑ No Y.,
Sign lure f claimantI hereby certify the above statements are true,correct,and comp) e. _—nnMn
A j? 4
Address of contact(number and street,city,slate,and ZIP code) Address of vacated homestead,if any(number and street,city,state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately '
surrounding residential improvements I (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.ne-half(1/2)of the a essed value of the mobile home or manufactured home.
Sign-• o ditor f Date signed month,da,year)
. rr��rIt�a0. 0
DISTRI s UTION:Original-County Au itor,File-Stamped Co payer
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