Homestead_Ricketts ..• a CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
r� STANDARD/SUPPLEMENTAL DEDUCTION ^�
° l� State Form 5473(R18/1-20) I HCl O p/
_ • 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 arC7lAmt-rm '
(We) �_ „ 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
Deductio is hereby claimed on the date this application is signed, G/c VOA (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 owners name
Recorder's office where contract is recorded Record number 'Page
PROPERTY DESCRIPTION
County ::::::
Taxiny tlIs!nct( II ! ,DPrcel number cription Is the question.
4/�/�`\4_•I -5 1 -aOO-O oo ^G _}^��s 1` 1 111 BEaI property ❑Annually assessed mobile home(IC 6-1.1-7)
If any portion the residential structure or the(land not exceedingne(1)acre that immediately surroundsstthhaat structure is used to produce income.describe the AM pi o8 '022
of the property utilized to produce income •
PROPERTY OWNED ELSEWHERE BY CLAIMANT U D I TO R
State.County.and Township Is claimant vacating a homestead?
❑ Yes
re rs.
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state.and ZIP code) Ad• - o vacated homestead.if any(nu-• r d street,ci .state.and ZIP code)
// - • .A./MI/
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-VAL
ESIDENTIAL
Land not exceeding one(1)acre immediately (1) 1. i a-
surrounding residential improvements _.. s.
Other land (2) _ s 7:i
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5) _ ., _ _ _
Other improvements (6) ' --
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (a) _
Signature of Assessor Date signed(month,day.year)
I hereby certify the above Is true,correct,
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 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.
Signature of Auditor Date signed(month,day.year)
V l
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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