Homestead_Edwards (4) -,--, CLAIM FOR HOMESTEAD PROPERTY TAX __YEAR T
STANDARD/SUPPLEMENTAL DEDUCTION FORM .
440..) State Form 5473(R18/1-20) HC10 (1,9
. .
Prescribed by the Department of Local Govemment 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) • •• D certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
De ction is hereby claimed on the date this application is signed, (date of signature). I(We):
Own. E Am(are)buying under recorded contract.
Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
n ave a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
[1] A (are)the shareholder, partner. or member of the entity that owns the property.
CLAIMANT'S INFORMATION
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION ct
County Townshi Taxing di let(city,town.township) Ma 0
(..... A,,..s.
Parcel number Legal description Is the prist +reqrrestion 2 .......,, .,,
z4-/Z--/1-2z.z.2- C-1!)/-.__. ),_.5-- 0.0 4-71 [CA'Ffeal properly El Annually assessed mobile home(/C 6- 1-7) >-.
•it any 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 porn o C'll Z
of the property utilized to produce income =
11.14 LJ__I
Z
0
PROPERTY OWNED ELSEWHERE BY CLAIMANT j CTI
State,County and Township Is claA.,,,g1.4,16$57g a homestead? C
315 a 1-1--1) g 1za e..i Sec-,
Yes 0 No
a, tie ure of c mmant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state and ZIP code) Address of vacate homestead,if any(riumber.aWstreet,city.state.and ZIP code)
orie- •'.SCrj-..) /‘71,2.,422.,/ .------?' 5 i 52 E.-- 505- i-razinC-4, 5,-.4D
NON-RESIDENTIAL
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE 1
, VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1) is_.:4,,,..h-',,`-%:', ----,',
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) ,,6t.';':',,r'.,.'„',:--f 1`,,,:''t•--:--,',.''::;',',
annually assessed mobile/ '-r.-:".',- -.':>-:-',,,',,- --.%i,,,,+,:2F'
manufactured home Garage (5)
Other improvements (8) Imear,- ...,'.:41;tvr MI 4
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line
C8,1 .-"•••" <
>t.
Signature of Assesses Date signed(month day.year) Cr4
I hereby certify the above is true,correct, ..and complete, C1-11
=
Verifying action-Signature of Auditor Date signed(month,day,year) (....-., 0
c4,,,,,,i2-- /1 n/c,4icu75, f / 2--2.9-202)Y-1-i 1...0
STANDAR.)DEDUCTION ALLOWANCE (S
MP, - Cl:
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. 03
—
0
Notwithstanding any other provision,the sum of the deductions provided in/C 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-haff(1/2)of the assessed value of the mobile home or manufactured home.
pjn,A.d.tor , Date signed(month,day.year) .
411,6Wei__ Qr_&._a&ir_ lay 29, 2.E) 2_/
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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