HomeMy WebLinkAboutHomestead_Mallory CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
�'� FORM ^^
STANDARD/SUPPLEMENTAL DEDUCTION ��
x ti State Form 5473(R18/1-20) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under lC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) AFM.70 Q/GI certify that I(we)occupied as my(our)principal
place of residence or am(a - buying the following described real party under contract for which a Homestead Property Tax Standard
Deduction is hereby claim=#1,on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract.
❑ Am (are)entitled to occupy 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.
Cl Am (are)the shareholder, partner,or member of the entity that owns the property.
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number of claimant's spouse(lest five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number)
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
si Totes- Taxi Oct di -ct(city to towns
1 number Lega nation Is the properly in sue on:
�/�j/{f�/(�l-ao O /OD*CVO. ���j•y OO/ <Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
- If any portion of the residential structure or theth Ian tl not exceeding one(1)acre that immediately surroredds`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?
❑ Yes ❑ No
Signature o an[
I hereby certify the above statements are true,correct,and complete.
Addre of (num and se y,state.gad ZIP cod-) - ess o estead,if any(number nd street,city state.and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (t) 1 f' F _, ;'�'` v
surrounding residential Improvements f•
Other land (2) . •
I
Total land(line 1 plus line 2) (3) i
Residential improvements or Dwelling (4) - '~
annually assessed mobile/ p ""it),:"f`"c` '4""`'0�
manufactured home Garage (5)
Other Improvements (6) rj9 se s' a
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) F(8) ����
I hereby certify the above is true,correct, Signature of assessor Date sigh ar)
and complete.
V.- ing action-:igna re of Arid'• Date signe (m d year) ,
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. / 6 202
CI
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 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 Q/
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home. BSON _
Signature of Auditor Date signed(mogl gj
/TOR
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2