Homestead_Michels C
-^, CLAIM FOR HOMESTEAD PROPERTY TAX FORM 1 YEAR
i;1 .) STANDARD/SUPPLEMENTAL DEDUCTION I ��n
State Form 5473(R18/1-20) HC10 !R
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 IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) , e r;,,. N% • • e m►C-..1c--k__ _ 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
Deduction_ /' is hereby claimed on the date this application is signed, 2�—'�j—cP Q a.1 (date of signature). I(We):
f�Qwn. ❑ 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.
CLAIMANT'S INFORMATION
CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
Co my Township Taxing district(city.town,township) _
t\(— sew- iI. 6t,ipt r\3\, $ i en.
Parcel number Legal description Is the grope n question:
al property ❑ Annually assessed mobile home(IC 6-1.f-7)
If any portion of the residential structure or the land not exceeding one(t)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property uti//reed ttooproduce inoome. r-� 4
" _Li2 `�\_3 -C ('� - I� - o0. /, \ G7 --cn .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Slate,County.and Township Is claimant vacatirq,a.homestead?
I ❑ Yes [ 'No
Signature of merit
I hereby certify the above statements are true,correct,and complete. te �
Address of contact(number and street city,state.and ZlP code) Adtlr ss of vacated homestead.if any(number and street.city,state,and ZIP code)
• 3 . -. c�O — s — 111 - IP Ilk -.1Il.
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1) rF ? " C
surrounding residential improvements �.
Other land (2) c ' V,' i¢;.,l"'�':� __._..._
Total land(line 1 plus line 2) (3) D
Residential improvements or 1 Dwelling (4)
annually assessed mobile/ --—' ----_--- ;� ss�'"-; 7
manufactured home Garage (5)
Other imp ovemems (6) p'.ge ,t, ,..f DEC 0 12J
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) ___ -d)1
Signature of Assessor Date��tl qqV� rr��,t V (,v` ' NTY AUDITOR
I hereby certify the above is true,correct,
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 Auditor Date signed(month,pay,year)
DISTRI@U N: Original-County Auditor,File-Stamped Copy-Taxpayer
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