HomeMy WebLinkAboutHomestead_Kempa CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
tot,* STANDARD/SUPPLEMENTAL DEDUCTION FORM 2022
State Form 5473(R18/1-20)
lu 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) Doris L.Kempa certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, 4/28/22 (date of signature). I(We):
21 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.
CLAIMANT'S INFORMATION
I //.TT��.
Social Security number of dalmanl's spouse(last Ave digits) Driver's license/Identification/ /D1111r r f ima spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does no ial security number.)
4 •a .
CONTRACI RrTCC.dDr
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded v/B8O11/C UQ Y,f�
Record number Page
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PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Gibson Barton Barton
Parcel number Legal description Is the property In question:
26-21-32-200-001.713-001 PT NE NE 32 3 8 1.72 AC 0 Real property El Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately surrounds that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,end Township Is claimant vacating a homestead?
❑ Yes 0 No
Signature t ant
I hereby certify the above statements are true,correct,and complete. ,J`�♦/ A�rG ✓/
Address of contact(number and street.city,state,and ZIP code) Ad ess a vacated homestead.I n num en treet,city.s 1.and ZIP code)
9532 S 1325 E,Oakland City
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one improvements)rcre Immediately (1)
La not ing re onl crImmediately
-F iti. ip
Other land (2) - -
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) p,PR 2 8 2U22
annually assessed mobile/
manufactured home Garage (5)
Other improvements (8) - ""'
Total improvements(line 4 through line 6) (7) G1gr.ON r OUNTY AUDITOII
Total value (line 3 phe line 7) (8)
1 hereby certify the above Is true,correct, Signature of Aaseasor 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 IC 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-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date apnea(month,day.yeM
`1-1- - gyp„ �>-r—�) col t— —moo ;-- ..
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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