Homestead_Maikranz ., -1"--- CLAIM FOR HOMESTEAD PROPERTY TAX
1 YEAR
l, STANDARD/SUPPLEMENTAL DEDUCTION FORM
littotw.1 State Form 5473(R18/1-20) HC10
C
`' .., , Prescribed by the Department oftocal Government Finance
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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. 1111)
CERTIFICATION STATEMENT I'
I(We)._ AILMIffillis fr alairrilii/W..-... A : .4 AP - certify that I(we)occupied as my(our)princi.9
__. .
place of residence or am(- e)buying the following described real property un.or contract for which a Homestead Property Tax Standard _
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
4.20,/,:. El Am(are)buying under recorded contract.
El 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 personal residence trust.
El Am (are)the shareholder, partner, or member of the entity that owns the property.
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)
Parcel number Is the prop question
2/0-20-D.2-1/42z-c62'). 3/7Z- e4_. property LI Annually assessed mobile home(/C 0-1 7-7)
If any portion of the residential structure 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?
E] Yes 52,1
Signature of claimant .
I hereby certify the above statements are true,correct,and complete. 9"1-4 ,:__4_
Address of contact(number and street,city state,and ZIP code) Addresst of cared homestead,if any(number an net,city,state,and ZIP code)
/0 7-z,, e - ‘,. .),L. taLkIa/A6e /€2,71 3,i-e,qa,..4-t-, C241,-14.44e 6-17, k-X-2/74126
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ASSESSOR USE ONLY ASSESSED VALLEZ- HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
andno 'cA onei)aei7YrlateIY
surrounding
= inprgftrr (1)
Other land (2) k
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) -'i;'''7.':: ,
annually assessed mobile/
manufactured home Garage (5) - a
Other improvements (6)
C`s.J 0
Total improvements(line 4 through line 6) (7) 14
).-
Total value (line 3 plus line 7) (8) erz .I hereby certify the above is true,correct, Signature of Assessor Date signed(month day.year) C.11 E and complete. C.._) 0
Verifyint action-Signature of Audito& Date signed(month,day.year) paimmill Lii 0Ai I -A w-,-.i 1 . Mil -,1 s (=) z
o
STANDARD c ED,ICTION ALLOWANCE j CUD)
20 pay 20 Lesser of 60%of the assessed value e homestead or$45,000. cp
Notwithstanding arty 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.
Dateligrl(m nth,
Signe e of/Auditor A_a„cci)
DISTRIBUTiON: Original-county Auditor.File-Stamped Copy-Taxpayer
Pagea,