Homestead_Cornwell (2) FORM �
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
/_ i�j' �...� STANDARD/SUPPLEMENTAL DEDUCTION HC10 462-Z
'• k,, is State Form 73(De /1-20) _.
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 fe eral identification nu ers are conk a ial under IC 6-1.1-12-37,
I(We) (e- certify that I(we)occupied as my(our)principal
place of resi or am(are)buying e ollowing described r al property under ccl tit act for which a Homestead Property Tax Standard
\Deedduction is hereby claimed on the date this application is signed, (date of signature). I(We):
X[J�Own. ❑ Am(are)buying under recorded contract.
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.
CLAIMANT'S INFORMATION
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County Township —-- — Taxing district(city,town,township)
Son - 0 � ^
Parcel number Legal description Is t property in question:
Real property ❑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 surrou s at structure is used to produce income,describe the use and portion
of me property utilized to produce income.
a6- 01 -59 -03 2 - Oc . 1,54-- O 19
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant Va a g a homestead?
❑ Yes No
S t re o/claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street.city,state.and ZIP code) A s of vacated homestead,if anybar and street,city,state,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALVE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE _
�/ cc Land not exceeding one(1)acre immediately (1)
surrounding resldenttat improvements . -.I
0 Other land (2) 1
O ,. Q Total land(line 1 plus line 2) (3) --- _ o _ -'
• 7L—Tt^—J7 N !-Residential Improvements or Dwelling (4)
LfJ t"annually assessed mobile/
L^\J 0 � manufactured home Garage (5)
I r r
-I VOther improvements (6) � m
'— tZTotal Improvements(line 4 through line 6) (7)mi —
ID
otal value (line 3 plus line 7) (8)
Signature of Assessor Date signed(month,day,year)
q 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 lC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manuf-=cured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed vat mobile home or manufactured home.
Signature of Auditor Date signe (m th,day,I year)
M -� 1 Z
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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