Homestead_Lamey (30) ."--!---,$ CLAIM FOR,HOMESTEAD PROPERTY TAX YEAR
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'• STANDARD/SUPPLEMENTAL DEDUCTION FORM
9 State Form 5473(R18/1-20) HCIO
• e• Prescribed by the Department of Local Government Finance -—- —
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security.dnver's_license,state identification and federal identification numbers are confidential under IC 6_1.1-12_37__f_:__ __
CERTIFICAl1ON,STATEMENT
I(We) D Qtf 1\t_-1 QLY1m _` certify that I(we)occupied as my(our)principal
place of residence or'am(are)buying the followin scribed real property^ under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed,�!= ° Qa( (date of signature). I(We):
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 of a qualified personal residence trust.
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
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Social Security number of claimant's spouse(last five digits) Driver's license/Identification I Other number of claimant's spouse(last five digits) Issuing Stat>
(Applicable only if applicant's spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name — '/" 20
•
Recorder's office where contract is recorded Record nr
SON Cot
J PROPERTY DESCRIPTION T
County Township district(city,town,lawnship) OR
5. �•( 1 'C h r1�
�• Parcel number Legal description Is the property in question: '
n/ 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.
a .e- '2.3 - 1 -300 - ooD Ui l -- LA
PROPERTY OWNED ELSEWHERE BY CLAIMANT
state county,and Township Is Gaimant flog a homestead?
C es ❑ No
Sidaimant T
I hereby certify the above statements are true,correct,and complete. 4C
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Address of contact(number and street,city,state,and ZIP code) Address of vacated homestead,if any(number and sire ,city,state,and ZIP code)
(� °1'.4:L1 • W(1Lrr- •rL\R4 . , . Lk g & • 1 OO • ... `' 1-a-d1-
\l`QLIDa / ASSESSOR USE ONLY I. ASSESSED VALUE HOMESTEAD VALUE NON-R SIIDENTIALVAL N
Jt • Land not exceeding'one(1)acre immediately
\ surrounding residential improvements- (1) ^�
N Other land (2) V4"
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) - 04
annually assessed mobile I =
manufactured'home • Garage (5)
Other improvements (6) Q
Total improvements(line 4 through line 6) (7) O
Total value (line 3 plus line 7) (8) N
I hereby certify the above is true,correct, Signature ofAssessdr 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. . . (^l�
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ s
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 Auditor - Date signed(month,day,year)
y-{)i C Q Q --\),M®3-' i r,a,t) cc- a-0)0.. I
DISTRI6 ON: Original-County Auditor,File-Stamped Copy-Taxpayer
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