Homestead_Cooper i,-- , CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
ON FORM
: ,,i; STANDARD/SUPPLEMENTAL DEDUCTION
! L. State Form 5473(Rib/1-20) HC10
,-Ea,-? 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) M. "M a a MilleiliL /4'1 certify that I(we)occupied as my(our)principal
place of residence or am(-re)buying e TOIlo-wi•. .escribed -al prod rt2..n r c,get for vl3iish a Homestead Property Tax Standard
Dedu ion is hereby claimed on the da e this application is signed, IL'i (date of signature). I(We):
Own. El Am(are)buying under recorded con act.
A (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
CLAIMANT'S INFORMATION
It buying on contract.Fee Simple owner's name
Recorder's office Where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township 2._,.. .,..,..------- Taxing district(city town.township)
Parcel eumbrl,,r Legal desolation Is th roperty in question
eal properly Et Annually assessed mobile home(IC 6-1 1-7)
If any portion of the residential structure or the land not exceeding one Ill acre that immediately surr rids tha structure is used to produce income,describe the use and portion
of the property utilized to produce income
1 g •-• CDI( '-.Lk°(:).'•-• °C)2*-- • ti '1g D -02-3--
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is r i••nt va•.ti , -homestea..
,4): Yes II
,,i'. A
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state.and ZIP code) Address of vacated horn.. 'fl7.ff'(nu),r and sae- cay state.and ZIP code)
Ale r ..iat
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE IJ JN-RESIDENTIAL
, VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1) t •Lirt,"•.)Y'
,,..,
Other land (2) k 3t.w, ,,z- ,'IA:',--,-, ::•..
Total land(line 1 plus line 2) (3) -II
Residential improvements or Dwelling (4) 4
.',7:4•4:i'A',2frA- ,''•!':, -1'?••,r1-;•-••• .•‘14
annually assessed mobile I ,--z.,-,-;-7, -,-...:,44.-,;,,, ,,,,, '--;4.:
manufactured home Garage (5) I 1 5 2021 , •.-- .-- .- -. •, , .. ,,,,,
Other improvements (6) lattUfFiW""1"""tai;AM
Total improvements(line 4 through line 6) (7) All,IIIIIINIxMfie API.
Total value (line 3 plus line 7) (8) rz, : • ,,„ COUNTY AUDI OR
I hereby certify the above is true,correct, Signature of Assessor Date signed(month day year)
and complete.
Venfying 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 a obile home or manufactured home.
Signature of Auditor Datet sAner(rronp,,c/ ,year)
-2-
.
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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