Homestead_Crabtree (5) ,--:-.--0i,v-, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,(Iiik.j STANDARD/SUPPLEMENTAL DEDUCTION FORM
14410,,1 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 IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) . ..-N"),e) . certify that I(we)occupied as my(our)principal
place of residence or a are)buying the following described real property_uncler ntract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, lisM-7"".4.-- " (date of signature). I(We):
Ve.}P k --iN
—\ % ) tg(Own. 0 Am(are)buying under recorded contract.
Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
6
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
CI Am (are)the shareholder, partner, or member of the entity that owns the property.
_ CrilVirTrcpri.:
)
i CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded
r'
Record number Page
County Township Taxing district(city tovvn.township)
—
Parcel number Legal description i Is e roperty in question:
I
Real property 0 Annually assessed mobile home(iC 6-1.1-7)
, .. r__..0%
- ( .
t icoC1"
Of
I a- PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacpligo a homestead?
El Yes No
\le-Ae- • .-•natur. ds'zst if
thereby certify the above statements are true,correct,and completeX ''‘..
ijAddress of contact(number and street.city state.and ZIP code) A•• 'us of vacated homestead,if any(number and street,city.state,and ZIP coda)
'N-1-1-3Vt.1
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
isl.rnrcic.noWgcereescliisegnorziWpreocvreemirrtrliately (1) .
r Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile! .iiiii....'- :i..-..1.a.a:-.',..,-.....v..,....,,iLa.,,
manufactured home Garage (5) . . .-
•--.-,.,, ..... . .
Other Improvements (6) .r-,v--r',,4-'i' n'''.:-.•-.V.,' ---; 0','i'.',',•-..,i
Total Improvements(line 4 through line 6) (7) APR 1 8 20
Total value (line 3 plus line 7) (5)
1.14nry...rap,the above Is true,correct, Signature of Assesso a.jicark.;,..) Date signed(month,day.year)
—L-
Verifying action-Signature of Auditor GIBSON COUN I Y 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/C 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-haff(1/2)of the as e of the mobile home or manufactured home.
'' SignaturefilSuiliAorx Date s' ed(mon .day.year)
DISTRIBUTION: Original-County Auditor, ilfirsnsmped Copy'Taxpayer
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