Homestead_Schneider (2) M. a. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
3 STANDARD/SUPPLEMENTAL DEDUCTION FORM
a ep Z^
Ft.`/ I-IC 10 I 20'Z'�
^r'L ' r��1 State Form 5473(R18/1-20)
x
'V �.� Preuribed by the Department of Local Government Finance
CTIONn:. o a erseSec side for filingr instructions.
as.
k4� NOTE Telephone,Social Security.driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTI'ICATION STATEMENT
I(We) 1 .1 t7.We _-` IM� e'AP"- certify that I(we)occupied as my(our)principal
place of residence or am 1-=)buying the following described real propertyyydel p9ntrec?for which a Homestead Property Tax Standard
Deduction is hereby clai on the date this application is signed,
�� // !/V (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.
CLAIMANT'S INFORMATION
If buying on contract,Fee Simple owner's name
— Record number Page
Recorder's office where contract is recorded
PROPERTY DESCRIPTION
Coun / Township Taxing di r�toyvn.township
2�
rcel number • Legal description t e roperty in question.
oil /V W w-M: A, •� 9 ,/ ' Ly Real property ❑ Annually assessed mobile home(IC 8-1.1-7)
If any portion of the residential structure or thMellandd'a not fexceeding one e((+1)acre that immediately surround that structure is used to produce income,describe the use and portion
of the property utilized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Is claimant vacating a homestead?
State,County.and Township '
� ❑ Yes ❑ N`
Signaturs,ol uaimant . / /
I hereby certify the above statements are true,correct,and complete. _,' r r."` / ..[�� A(`✓/"
Atl•ress of contact(number and street,city state.and ZIP code)
Address of vary r homestead.If any(nu - r and street,city.state.and ZIP code)
w/voo ✓ ,A,ub✓14-
•
- -
NON-RESIDENTIAL
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE VALUE
t[rt M7iY .cF',.`6,
Land not exceeding one(1)acre immediately (1)
surrounding residential Improvements _ - -- - ---
Other land (2)
Total land(line 1 plus line 2) (3F 111
- -
Residential improvements or Dwelling (4 - r-'- -t'tt^`-
annually assessed mobile I Garage (5)
manufactured home
Other improvements
(6) MAC I 0 202. _. .. ;-k ''.°_
Total improvements(line 4 through line 6) (7) �,r.
Total value (line 3 plus line 7) _ - -i�1fi�w
e�s.tspe T fer Date signed(month.day.year)
1 hereby certify the above Is true,correct, �v
and complete. __-- - - ----- Date signed(month.day year)
Verifying action-Signature of Auditor
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 S
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. Date sig d(mo to^,day.year)
�t
Signature of Auditor `� & ' I i a3 2
DISTRIBUTION: Original.County Auditor.File-Stamped Copy-Taxpayer Page 1 of 2 1