Homestead_Do (2) 4 CLAIM FOR HOMESTEAD PROPERTY TAX .•4
4low STANDARD I SUPPLEMENTAL DEDUCTION FORM
x.'£y State.Form 5473(R18/1-20) HC'10
r'\'! � Prescribed by the Department of Local Government Finance O�
.
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state Identification and federal identification numbers am confidential under IC 6-1.1-1 37.
CERTIFICATION STATEMENT
I(We) Kim VanNan H/Yena Nil-homes V Do 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
Deduction is hereby claimed on the date this application is signed, '( i i"vI '"%" (date of signature). I(We):
® Own. ❑ Am(are)buying under recorded contract.
❑ Am(are)entitled to ono 1py as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder,partner, or member of the entity that owns the property.
)
CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(coy,town,township)
di lOSOW f0f"r (;()-A14c4 `vl,r- a -..r +
Parcel number Legal description Is elye property in question:
/Real property ❑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.
26-19-18-101-001.177-026
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant ,..' . • =stead?
1 K g 21!-WI f G)i(3 5*Ai ( f� - f3 Ile-nee ri : ►I No
Signature of dal,-nt
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 • &,H any(number and street,city,state,and ZIP coda)
912 Mohawk Dr,Ft Branch,IN 47648
ASSESSOR USE ONLY ASSESSED VALIIE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (i)
surrounding residential improvements
Other land (2) ,,�^
Total land(ling 1 plus sine 2) �` .
1 `�J,
Residential improvements or Dwelling (4)
annually assessed mobile/ r�
manufactured home Garage (5) , cat
Other improvements (6) \P\`s r
J e
Total Improvements(line 4 through line 6) (7) 4 t�- P).:(
Total value (line 3 pits line 7) (8) "�y
Signature of GO Date signed(month,day,year)
I hereby certify the above is true,correct, SIN
and complete. Q*S
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 130%of the assessed value of the homestead or 645.000.
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 properly or/0 a manufactured home that is not assessed as mat property may
not exceed one-half(1/2)of the asse of the mobile home or manufactured home.
Signature of Auditor Datesited( de Year)
�� t \Z to Z -
DISTRIBUTION:Original-County Auditor,File-Samped Copy-Taxpayer
Page 1 of 2