Homestead_Sisk Jr CLAIM FOR HOMESTEAD PROPERTY TAX
iYEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
. State Form 5473( 8(1.20) HC10
a
Prescribed by the Department of Local Government, Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone, ocial Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
r,ERTIFIcATION STATEMENT
I(We)_ •_Le^.Xt,........XAIIIWIIIVIMII. Illrl..0 certify that I(we)occupied as my(our)princip.'
place of residence or am(are)buying the following described real prirrty under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
Ii-ll Own. El Am(are)buying under recorded contract.
0 Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified persona? • trust.
El Am (are)the shareholder, partner, or member of the entity that owns the property. 04,
CONTRACT RECORDED
It buying on contract,Fee Simple owner s name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
.unc Township Taxing•'-riot(ci town,to ship)
i ::)/ • ‘/X....) ...1 eilW__
Parcel number Legal description , the pr e•,,, question' 4
.-(DO e140. 'n-:9'="2/ Real property El A - ally assessed mobile home(IC 6-1 1-7)
If any portion of the residential stiucture or 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 income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Li Yes El No
,sn re clai t
thereby certify the above statements are true,correct,and complete. rig
I
j,
Address of contact(number and street.coy state.and ZIP code)ear,aei..,.. i.i „1.e,/Ai Address of vacat d homestead,4 any(number and street.city,state,and ZIP code)
, ,63 Gt.,-
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1) .4T44:;fittiTeik-A,''''TW l77':',Z,`
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements (6) 443V.',7-'7 4WM,- •
[Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
Signature of Assessor Date signed .y
lahnnMic,(1,:gfy the above is true,correct,
Venfying action-Signature of Auditor Date signed(mont at)
STANDARD DEDUCTION ALLOWANCE -
20 pay 20 Lesser of 60% the assessed value of the homestead or$45,000. i 202 1
Notwithstanding any other provision,the sum of e deductions provided in IC 6-1 1-12 to a mobile home $ 0496,
that is not assessed as real property or to a man factured home that is not assessed as real property may OA,m c c---. ..z..„ .
not exceed one-half(1/2)of the assessed value of the mobile hoe or manufactured home. Oit ' .
Signatur itor
Date signed(month,cW7Y07.1ii
I'l.1.7/ 44.:A•icijof 7.
la 4 4 a f_..4 /.142 Ofi4
DISTRIBU ION: Original-County Auditor,File-Stamped Copy-Taxpayer
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