Homestead_Lamey (31) . ,,-....rN,-, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
.4, . 1 SUPPLEMENTAL DEDUCTION FORM
Cr--
State Form 5473(R18ht 20)
". ,, .., Prescribed by the Department of Local Government Finance
( ) STANDARD/0___,
HC10
'7-02 t
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) 4,AA - certify that I(we)occupied as my(our)principal
place of residem s .. am(are)buying the followin.described real prope u r contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this ap.• ation is signed, 1.......2.4 (date of signature). I(We):
XCIOwn. E1 Am(are)buying under recorded contract.
Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
0 Am (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city town,township)
Parcel numb Legal descnpfion Is t operty in question'
Real property E 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 sorb o ds th t structure is used to produce income,describe the use and portion
of the property utilized to produce income
2 C- 22_—12--,S0 0 — c),02- - \-4-3 —02_/A
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is .i -nt vacating a homestead?
P,1 Yes Et No
, natzt lof ::
I hereby certify the above statements are true,correct,and complete.
• Sg ; .........."
Address of contact(number and street.city state.and ZIP code) Address of vacated homeste-41111Orrumber and str city.stet.and ZIP code)
‘1 16 S\ SDA.J3 ir.._I _ . ..S . W O4e .
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
1 1 I VALUE
Land not exceeding one(1)acre immediately : ; kt
surrounding residential improvements (1) E,14--i : ,fir,e,T.,,,,i41;..-.z,., ,5t.i,°
Other land (2)
Total land(line 1 plus line 2) (3)
F I I • .,,,„„,,,,„,„,„•,„:„.„,,,::,_::::-„,„:::,,,
Residential improvements or Dwelling (4)
annually assessed mobile)
manufactured home Garage (8) ':•,i:,,,,,',1 ?& '..)..,t:::I.:,.,-
Other improvements (6) DEC -..,6
,-: ..;,. .,'--,-,.. ,,, .:
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) le _ai, ,
lat=yzgiefy the above is true,correct, Signature o 4.•...•,1.-8 N COUNTY AUDITOR Date signed(month day year)
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 me home or manufactured home.
Signature of Audittgai x•-. Date stgn- mor(th.day,...jaa)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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