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HomeMy WebLinkAboutHomestead_Cardwell (2) R,4. CLAIM FOR HOMESTEAD PROPERTY TAX FORM 1 YEAR STANDARD/SUPPLEMENTAL DEDUCTION HC10 I aba� State Form 5473(R18/1-20) 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) Lr'}V Wt4/\ l A V�Q V s certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following described real property and r contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, fa-' AI-a% ._ (date of signature). I(We): [ wn ❑ 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. CONTRACT RECORDED If buying on contract,Fee Simple owners name Recorder's office where contract is recorded Record number Page PROPERTY DESCRIPTION County Township Taxing district(city,town,township) %'Sbn /AMA* or e e.-•-) AACTAA-Vine r D Parcel number Legal description Is the propertyffil question arI-1**'Di** 10 0 he I`}'Healp p Elty A ally assessed bile home(/C 6-1.1-7) It any portion of the residential st 111)1Dk .r 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 in PROPSKTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is claimant vacating a homestead? 171) Yes ❑ No - --- '" -' e a of claimant I hereby certify the above statements are true,correct,and complete. �bl 'l Addressdr of contact(number11 '`� a(njy]i/treet,city state an. P code) . -ss of vacated homestead,i ny(number and st eat,city,slate,and ZIP code) \O. - ` ) C L _�. .. t _' I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL ASSESSOR USE ONLY nVALUE Land not exceeding one(1)acre immediately (1) -� ,.,»., t.,rt,• a : surrounding residential improvements % A. Other land _ `''aa � Total land(line 1 plus line 2) (3) / Residential improvements or Dwelling (4) h/V// annually assessed mobile I '- �- -- ., manufactured home Garage (5) - Other improvements (0) ';g0'' '' r '`w'�- Total improvements(line 4 through line 6) (7) �_--�p5LJ©*T OR Total value (line 3 plus line 7) (8) -,_,- t SON COON 1 Signature of Assessor Date signed(month,day.year) I hereby certify the above is true,correct, 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 Aydttor /� ,-y� �- / Date signed(month,day,year) �e tltrh litor oor otio "7_..4. ' is- off-a DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer Page 1 of 2