Homestead_Henson (4) •^r. CLAIM FOR HOMESTEAD PROPERTY TAX r FORM YEAR
� t STANDARD/SUPPLEMENTAL DEDUCTION I �a
.4State Form 5473(R18/1-20) HC1O
_ 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.
I(We) EVa S
nge I IIAQ 1- I?/15I et certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property undqr contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, gif 8/�to (date of signature). I(We):
DI,Cfwn. ❑ 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.
❑ Am (are)the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number of claimant's spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number)
CONTRACT RECORDED _ ..46/b
If buying on contract,Fee Simple owner's name A //��
Recorder's office where contract is recorded Record number Page�- 061 .
Coun7. Township •Taxing district(city town.township) UN
,b�,rX o/1+op pviar y T YAu
Parcel number Legal description I Is the propfrty in question: /T'0
J^ _''''') (0(1 Too—o-- }V9rr���'✓� ac
e� \ 1 AO eal property nually assessed mobile home(/C 6-1.1-7)
I/any portion of the residential structure or the land not exceeding one(I))acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce inrggreO_ 003•$ o,S /
TTt'�/ PROPERTY OWNED ELSEWHERE BY CLAIMANT
Stale.County.and Township Is claimant vacatiinggavr,a homestead?
❑I Yes LTi
Signature of Gelman - `�7.)4 2:0"1-
(
I hereby certify the above statements are true,correct,and complete. /C/�iN�� ^
Address of contact(number and street\city state.and 2IP code) I Address of v led homestead.if any(number and street,city stela.and ZIP code) ,
- 7 0 vJ O w l lnsv* \e =J1/ /-I. L G 5-
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDNTIAL
V At UEE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)_ I -
Other land (2) .1
Total land(line 1 plus line 2) (3) 1.
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5) -
R R
Other improvements (6) — '
Total Improvements(line 4 through line 6) (7) •
Total value (line 3 phis line 7) (6)
I hereby certify the above is true,correct,
Signature of Assessor Date signed(month day year)
and complete.
Verifying action-Signature of Auditor Date signed(month.day.year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of - -ssessed value of the homestead or$45,000.
Notwithstanding any other provision,the sum of the-eduction provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manuf. lured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value• the mobile home or manufactured home.
Signatu• for / / ' / ♦ Date signed(month.day.year)
41
DISTRIB ION: Original-County Auditor.File-Stamped Copy-Taxpayer •
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