Homestead_Skelton �E' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
°i'lF STANDARD/SUPPLEMENTAL DEDUCTION FORM
C State Form 5473(R18/1-20) HC'IO
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) tli _ P nnq - -I'_ _ certify that I(we)occupied as my(our)principal
place of residence or am are)buying the following described real props ty r}ier rtt>)agLfpr rt1, a Homestead Property Tax Standard
�Deeduction is hereby claimed on the date this application is signed, (�` 'y b�� (.G.� (date of signature). I(We):
Awn. ❑ Am(are)buying under recorded co tract.
�❑ 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.
If buying on contract,Fee Simple owners name
APR 2 2 2022
Recorder's office where contract is recorded Record number Page
mismialciiiimiimimme( _ r
County Township Taxing tlbtrrolso ' . ns ip)
Parcel number Legal description Is roperty in question:
Real property ❑ Annually assessed mobile home(IC 6-1.t-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately Burr nds at structure is used to produce income,describe the use and portion
of the property utilized to produce income
\2 --O7- (41a<- _c - 00 0 -
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacating a homestead?
❑ Yes ❑ No
_ signet r
-
i hereby certify the above statements are true,correct,and complete. X /69��// n
Address of a tact(number and street.city.state.and ZIP code) �� // Address of vacated homeslea f any(number and street,city.state,and ZIP code)
n2:7 SSc i • S rmL -tl)C _
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1) ((.'y¢ i: _ i-`
Other land (2) y:143 �
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) } '-'fi
annually assessed mobile/
manufactured home Garage (5) •. '•-
Other
x
Other Improvements (6) �3��� � �•+��°
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
1 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)
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 IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured t is not assessed as real property may
not exceed one-half�� (1/2) the assessed value of the m it ome manufactured home.
Signature of Au 1 - p r(emon .,ds►:year)_ .
DISTRIBUTION: Original-County Auditor.File-Stamped Copy- yen 1I`�•y 1111 l///f`--'CCU/._
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