Homestead_Richardson CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
sktiov?�F STANDARD/SUPPLEMENTAL DEDUCTION FORM ."
HC10 d of
State Form 5473(R18/1-20) L____ _.
Prescribed by the Department of Local Govemment 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) C O-C O\ ' tC- e SOYA. 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
Deduction is hereby claimed on the date this application is signed, .4///.oZ (date of signature). I(We):
C) 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.
CLAIMANT'S INFORMATION
Recorder's office where contract is recorded
--- -- -_- - -- -- -- Record number Page
PROPERTY DESCRIPTION ^Cn _
County Township Taring district(city,town.to sunup)
G` I tb s 0 r '�" _. OcL��G.n� e �n z my
Parcel number Legal description Is the property in question: 0 Q
6-1 I-i -/A`�-CCO T \- ` �'7 eel property ❑ Annually assessed mobile home Q".r( 7') e r
7Vl VQf v p ` �J'rL yrl. - N
p rri
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 an r'
of the property utilized to produce income. D N
v�
PROPERTY OWNED ELSEWHERE BY CLAIMANT •
State, 'and II b e b� OQ�� / C Is claimant ting a homestead?
� 7 V„lY�i• es ❑ No
Si ure n claiman f t
I hereby certify the above statements are true,correct,and complete. �1...1.1 10 r r�/Sin
Address of contact(number and street.city,state.and ZIP code) Address of vacated homestead,if any(nu`!/rllbe d street,city,state,and ZIP code)
o D Al t� 5+ S+ ,_ 1 N�1�6w 5 .1 b;a S+,& '(1 CP y7t 6v
ASSESSOR USE ONLY
ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1) �iai-i:
surrounding residential improvements ------
Other land (2) - -
Total land(line 1 plus line 2) (3) . -
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5) : it ..-. - _. .. .. • -
Other Improvements (6) s wo,.
----
Total Improvements(line 4 through line(3) (7)• Total value (line 3 phis line 7) (8)
Signature of Assessor Date signed(month,day,year)
j 1 hereby certify the above Is true,correct,
and complete. -----
-- Date signed(month,day.year)
Verifying action-Signature of Auditor
i.
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 manufactur=• •me that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the .ome or manufactured home.
Signature of Auditor Detect
IN\
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
;° Page 1 of 2