Homestead_Hollander (3) 140 II•Ir\C
-•'« CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
FORM
STANDARD/SUPPLEMENTAL DEDUCTION HC1D I 2021
�' State Form 5473(R18/1-20)
• Prescnbed by the Depsneartt of Local Government Finance
S
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
She_ I(We) Baylee Hollander certify that I(we)occupied as my(our)principal
• S 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,
9/23/2021 (date of signature). I(We):
f I\e__ 2 Own. ❑ Am(are)buying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing
the terms of a qualified personal residence trust.
❑ Have a beneficial interest in the trust or the right to occupy the property
❑ Am(are)the shareholder,partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION
Dt.�/• (Applicable Dory if peptic-eel's spouse does not have a bola/security number)
I
CONTRACT RECORDED
f i ' /�.. If buying on contract,Fee Simple owners name
(!7�1 d• Record number Page
Remroars oaks where contract Is retarded
`^ PROPERTY DESCRIPTION
County Township racing district(W:toast.township)
Gibson Barton Barton
Parcel number Legal description Barton
Is the property in question.
26-20-11-100-002.221-001 PT NW 11-3-9 AC D-8 ,
Q Real property 0 Annual!? 7)
assessed mobile name(IC 6-1.1-
11 am/portion of hs reside situ Cure or he land not exceeding onee(1)M e acre that Immediately surrounds that structure Is used to produce Income.dateline the use and portion
Of he property ubll5M 10 produce income.
• PROPERTY OWNED ELSEWHERE BY CLAIMANT
{ r State.Crony,and Township s I.
Is claimant vacating a homestead?
a-{ ,ac.q, _ .b -� -�or-N ❑ Yes ®No
1 � ��Signature of claimant �r, ..dC.(h�
.,J� 1l I hereby certify the above statements are true,correct,and complete. r(pi ( M.t
` `\J�+"' `•' Address of contact(number end sneer,city,state.and ZIP code) JAdddrLesss2 of na tad homestead.If any(number and st stale,end ZIP code)
!''Q 5646 S 1000 E.Oakland City,IN 47660 I NON-RESIU F.NTIAL
J�_�Q�V ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE VALUE
�7'— ' t oundin•`reside oneresidential Im)acre•rov.ments immediately (1)
01-- ` k Other land (2)
Total land(line 1 plus line 2) (3) T
t ( Residential assessed
mobile
Improvements Of 1' rltIttg (4) �/�r/
�)vyt.? fly aawsaed mob0a I
manufactured home Gaspe_ (Si /(T/■
Other Improvements (6) �'�J
`;� Total improvements(lined through Una 6) (7)
p,„ "� otal value (line 3 plus line 7) (8) Ile,day.Year/ 2 x ,
Signature of Assessor 0/BO
1 hereby certify the above is true,wrreet, /Y'
�- ra 1`. and complete. Date agneref�
��J' vemying a�bo -sgnaty.of n wltor "7 'q - .
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000.
t,0/4%.- Notwithstanding any other prelusion,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 reel properly may
..V(2 _A--)—} N. not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home. Data synod(month say.year)
CdeV �1,}-1 Signature of Auditor \ CIr�2 _
I
DISTRIa ION:Original-Crony Auditor,File-Stamped Copy-Taxpayer `
Page 1 of 2
l‘..."
- M�� --- S ek._-- � - -