Homestead_Robling 0 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a '.e F STANDARD/SUPPLEMENTAL DEDUCTION FORM 1
Stale Form 5473(R18/1-20) IL HC70
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) I I OL .Qy I�',,^/-�� certify that I(we)occupied as my(our)principal
place of residence or am(are)It
•the following described real pro art un contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, 4- -Gam'. (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.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Townstup Taxing district(city town,township)
Parcel number Legal description j Is I petty in question,
i 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 surroun s th structure Is used to produce income,describe the use and portion
of the property utilized to produce income
2 '.- 0L- 12----Lk00 -001 - 56--C 2 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant v ca'ng a homestead?
❑ Y No
' ignatur lrJa•wp t /t
I hereby certify the above statements are true,correct,and complete. !(ffi/((��/�//yt/����
(Address contact(number and street.city,state.and ZIP code) Address or vacated home41.if an r d , ,slat,and ZlPcode)
56S�' •1cri �l I1`�r1-.�- 4't • VV
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1) 2 i -',x ':t(" "
u surronding residential Improvements _-
Other land (2) -
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) q rto��
Ily assessed mobile/ APR it L mom++-��w ..-m
manufactured home Garage (5) ,
Other improvements (6) i,.' a.^r ... p,''''
Total improvements(line 4 through line 6) (7) t-1B90N CpUNTY AU s TOR
Total value(line 3 plus line 7) (8)
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 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 $
,1 that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed v u the mobile home or manufactured home.
Signature of Auditor vocaki Date ned Imo ay,yea22
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
Page 1 of 2
ii
i