Homestead_Miller (7) .<... 7, - CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
. STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R18/1-20) HC10
C 0j
Prescribed by the Department of Local 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 -- A . -37. Sib.
CERTIFICATION STATEMENT
• ,
I(We) e e / certify that I(we . up' • , •• •place of of residence or am(or )buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of!Aft re).3(1E622
,...LOwn. [11 Am(are)buying under recorded contract.
E1 Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
LI Have a beneficial interest in the trust or the right to occupy the property under the terms of a ctefiy,fgcljzotpalaidpi,.•..dx.t.izd)
E] Am (are)the shareholder, partner, or member of the entity that owns the property.
: •. • . ... • •:
CLAIMANT'S INFORMATION
)
CONTRACT RECORDED
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) .
161.4.•'"eAet-,42.01/Uf.
Parcel number Legal description I Is the prope question.
olt-)0 ADO 01'1 Pil L eal property 0 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 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
Stale,County,and Township Is claimant vacating a homestead?
D Yes E.] No
-- Sig, ure of claimant xi,.
I hereby certify the above statements are true,correct,and complete. X it
Address of contact(number and street,city,state.and ZIP code)
xt
0 t^li lli ll II _41 1 ' At -NO_ my
Address of vacated ho e ,if any(number and street,city.state,and ZIP corli;)-
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE
Land not exceeding one(1)acre immediately (.1) '7 NON-RESIDENTIAL
7.— .- I_ ,
surrounding Jesidential improvements
Other land (2) k,.,. • -3
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) li,,.-, .,..i,;;,'„.'[.;'.'.'tt-'..-;':‘.'-i!,,-..**i..:,'!,•:-:-;,,
annually assessed mobile I 344413x4xiiti
manufactured home Garage (5)
Other improvements (6) :44,a4:_.', ?,, ..-, *.Iff
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
Signature of Assessor Date signed(mooM,dal,year)
I hereby certify the above is true,correct,
and complete.
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-/1-12 to a mobile home S
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.
Signature of Auditet ( Date signed(month.day.year)
) 61-- 57e4...14:41'...._ . _t..---
DISTRIBUTION: Original•County Auditor,File-Stamped Copy-Taxpayer
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