Homestead_Hicks (5) .^.4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
d STANDARD/SUPPLEMENTAL DEDUCTION FORM
t State Form 5473(R18/1-20) HC10 �2 1
° �Z�' -,:y; cribed by the Department of Local Government Finance
INST..'.T13<; -;:e reverse side for filing instructions.
Na ':�•7%-ph2n- ocial Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
..„ ..‘•t,r .' e) David G Hicks certify that I(we)occupied as my(our)principal
place of 9�i�\.ifce or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
t�u•De 'I,n`fs hereby clai ed on the date this application is signed, 01/19/2021 (date of signature). I(We):
J ,Own. . �Fl 0 Am(are)buying under recorded contract.
❑ Am ( e) � ,�xo occupy as a tenant-stockholder of a cooperative housing corporation.
❑ H-v ral interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
III ii, 0) e shareholder, partner, or member of the entity that owns the property.
O CLAIMANT'S INFORMATION
(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 I Township Taxing district(city,town,township)
So') 005
Parcel numberLegal description Is the property in question:
®Real 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.
26-13-19-202-000.159-005
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,county,and Township Is claimant v ca' g a homestead?
❑ Yes No
Signature of claimant I hereby certify the above statements are true,correct,and complete. i r/,,(�,llf1� n,
Address of contact(number and street,city,state,and ZIP code) Address of vacated homed,if (dUimb re and street,city,state,and ZIP code)
106 S 4th ST, Francisco, IN 47649
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
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 d'or r Y 1 V l Date signed(month,day,year)
1/19/2021
DISTRIBUTION: Original-County Auditor, '••d Copy-Taxpayer
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