Homestead_Williams (24) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
" % STANDARD/SUPPLEMENTAL DEDUCTION
• State Form 5473(RIB/1-20) HC1O P a
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) 1 LrOtO-5 1 s sCMV 5 certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract�f for which a Homestead Property Tax Standard
Deduction_ is hereby claimed on the date this application is signed, co �/oc�a t (date of signature). I(We):
I Oduwn. ❑ 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.
\S t1�/`rJ
t111 ��2�- •If buying on contract.Fee Simple owner's name
1 Recorders office where contract is recorded Record number Page
1Y PROPERTY DESCRIPTION
County Township inning district(city town.township)
....on _ {C> FI ED
Parcel number y Legal description Is the p�rop�,R_Y question:
076 /a-03- '_po-I i G ti3_o)7 "eal 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 surrounds that structure is used to produce income.describe the use a/tQ yo_rile 0 O�� /
of the property utilized to produce income. J Iu N 2 /,II///
'' PROPERTY OWNED ELSEWHERE BY CLAIMANT AUDITOR
State,County.and Township Is claimant vacating...—homestead?
❑ Yes No
Signature of claimant .
I hereby certify the above statements are true,correct,and complete. ,/ . -/ !pi1�
Address of contact(number and street.city,state.and ZIP code) Address of vacated homestead,if any(number and street.city,state,and ZIP code)
6.3/V 35oE 'riot • fag TA/ L 7G7o
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (l)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile l manufactured home Garage (5) _.
Other Improvements (6) F!ii.-- "- -- "-`
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (5)
1 hereby plete. the above Is true,correct,
Signature of Assessor Date signed(month,day.year)
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 $
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.
1
Date signed(month,day,year)
Signature of Auditor _ C /
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2
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