Homestead_Dunn (10) Zit
..R , CLAIM FOR HOMESTEAD PROPERTY TAX FORM
STANDARD/SUPPLEMENTAL DEDUCTION HC10 t�State Form 5473(R18/1-20) � ,►_
\ 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 federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) to. '( 1-4, .) D--k ("11 . certify that I(we)occupied as my(our)principal
place of residence or am(areY buying the following described real pr erty under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, •/ — s-• z ' 3"e_ (date of signature). I(We):
1„/n ❑ 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.
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number of claimant's spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does rot have a social security number)
If buying on contract.Fee Simple owners name
- �
Record nu �
Recorder's office where contract is recorded V` Page
Co ty Township - - - Taxing district(city town township) S`ON —v r i
`` r `• Legal d cnptiion`L� ` ___._ Is the D Pe in question COUno-,..
T y qU
Parcel number
property ❑ Annually assessed mobile.% C 8-1 1-7)
If any portion o/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
Q 2- t a.-C- , '--E() t -Do ( -- O
State, Township ^ Is claimant va ling a homestead?
`^� 1 J�,r\Ce r�11-40-_\ ❑ Yes No
t ` Signature of claii ant
I hereby certify the above statements are true,correct,and complete. V Tn 29
� �-
Address of contact(nummbrend sir.t,city state.and 2IP code) /AQ(ess of vocal d ho eslead.if any(number and street,G .state.en ZIP code)
ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
ASSESSOR USE ONLY VALUE
Land not exceeding one(1)acre immediately (1) x._t ;,.-.. " .a.%'•.�`
surrounding residential improvements _T
•t y,F^'1f
Other land (2j - - --T.,-.--
Total land(line 1 plus line 2) (3) --- .. ..;.
Residential improvements or Dwelling (4) _ t
annually assessed mobile/ Garage (5) - . --, - --
manufactured home _
(6)
Other Improvements 'y x - (.
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) - _ - ----
Signature of Assessor Date signed(month,day.year)
1 hereby certify the above Is true,correct,
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 $
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 signed(month,day.year)
Signature of Auditor tfi ♦ I..JC--X v f_ .
1i Cat �� L/ x r `-Z 2
,..
., DISTRIBUTI : Original•County Auditor,File-Stamped Copy-Taxpayer
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