Homestead_Kennard °Y of CLAIMSTANDARD I
FOR HOMESTEAD
EMENTAL PROPERTY DEDUCTI TA ONX
FORM YEAR
�►^
} State Form 5473(R18/1-20) HC10 !/:=)r�C:Z
_ 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 IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) •u... \ VG *ntiti certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real prppsrttu r c r ct for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, 11.I (date of signature). I(We):
Own. ❑ Am(are)buying under records con ract.
m (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.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
CLAIMANT'S INFORMATION
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County ^ Township /� C/(1 • r Taxing district(city town.township)
Parcel nunumber � 1 \, Legal descnpf tiioo1n -/----- -- I Is roperty in question:
Real property ❑ Annually assessed mobile home(/C 6-1,1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surro ds lh t structure is used to produce Income,describe the use and portion
of the property utilized to produce income
2_G-\7_-1 S 201 -oo0 . Is9_ 02Y •
State,County.and Township Is claimant va rig a homestead?
❑ Yes No
Signa /claimant
I her certify the above statements are true,correct,and complete. iy. _ V�V/��I� ,n - ,� '1
Address of co tact(number and street.city state.and -y0d Ad ress(of vacated homestead if If any(-numb a d street.city,state.and\ZIP fmde)
-1Z S - V) - ,- n-L\ e 0
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately '�, ) L .-
surrounding residential improvements (1) , '
Other land 2)
Total land(line 1 plus line 2) S _
Residential improvements or Dwelling 4) LE 3•'S';,'- ' '+.�
annually assessed mobile/ ��, ;at�a -
manufactured home Garage (5)
Other improvements l�APiT 0 7 'L0G 2-- r- _.. -- -- - --
Total improvements(line 4 through line 6) a /,, (7)
Total value (line 3 plus line 7) /" ce
I hereby certify the above Is true,correct,GrEISOt•Pe Date signed(month day year)
T
and complete, Y AUDITnR
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 ptuuided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured me tbet-tit assessed as real property may
not exceed one-half(1/2)of the/assessed value of the m ile home r nufactured home. r
Signature of Auditor fA_ 1 \eM,NT `.. Da nth- ,yes0 �7
T 11lW . v /HIVp !i
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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