Homestead_Richeson (2) CLAIM FOR HOMESTEAD PROPERTY TAX
° - YEAR
\ slats STANDAR
Form5473D SUPPLEMENTAL/ DEDUCTION FORM
(Ri/a t-zo) HC10 1.-702-
f
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under/C 6-1.1-12-37.
CERnTIF
IC�A,TION STATEMENT
I(We) e_c-r " Ca x--- '�-V\ am"'\ certify that I(we)occupied as my(our)principal
place of residence or am are)buying the following described real property under contract for which a Homestead Property Tax Standard
Dedu5l9n is hereby claimed on the date this application is signed, I I-"34')-",-- (:),?..1 (date of signature). I(We):
Irin,e5wn. ❑ 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.
If buying on contract,Fee Simple owner's name
Recorders office where contract is recomad 4 pi r AP
PROPERTY DESCRIPTION
County To(w►ship Taxing tlistnct(ctty town.toff:d
�(J Sc 1. — � C0U,V Y am\ ....
- r Legal descn Ption ris the property in question: qUi�
properly ❑ Annually as 9 Eli ce the home(/C 6-L 1-7)
If any portion of the residential structure or the land not exceeding one(i)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
4A.L> - 1 � t --‘s-0- C:)- jc C . C)DO-CC k .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is claims cating a homestead?
Yes ❑ No
Sigrcalure yr'glaimant
I hereby certify the above statements are true,correct,and complete. XX / '/�,
Address of contact(number end Street,city,state,and ZIP coda) � , � Address of vacated homestead,ii any(nu bar and street,city,5t:. - a d Z/P cotle)
« S. II '. P Le ,: , . S. .�-'' (�-vc. LA
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1) ��� �..I]&vtik � `.� ..`(4*lfl
surrounding residential improvements tit
.. c79,1/ �1
Other land (2) 7 "...
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) q . ,, �s;,r ;.
annually assessed mobile I --'' ""- -- . v,
manufactured home Garage (5)
Other improvements (6) r a iv`''PW
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
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(montn,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.
‘'\,,,'S�_i`gna�t`ur\e\ofof Aud, `AI- l \�� \I —�^�1
Date signed(month,day,year)
DI3Tf\RIBU"FO\N: Original-County Auditor,Ffl�e\-Stamped Copy-Taxpayer �
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