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Homestead_Kirsch
Oi CLAIM FOR HOMESTEAD PROPERTY TAX FORMYEAR STANDARD/SUPPLEMENTAL DEDUCTIONORHC1 �l�o`ZZ' Stale Form 5473(R18/1-20) •.. Prescribed by the Department of Local Govemment Finance INSTRUCTIONS:See reverse side for riling 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) _ •"IIIMMIIIIIIIIfR11. t11 - _ 11. certify that I(we)occupied as my(our)principal place of residency or am(are)buying •e following described real pro ittr €plc yact for which a Homestead Property Tax Standard Deduction is hereby claimed on the da e this application is signed, bb 1 (- -' (date of signature). I(We): XOwn. ❑ Am(are)buying under recorded/ 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. 1 Recorder's office where contract is recorded ---- --- - - Record number Page PROPERTY DESCRIPTION County �� Township 0^ Taxing district(city,town,township) Parcel number Legal description (/' i Is .1 •party in question: V\ i �� Real property ❑ Annually assessed mobile home(IC 8-1.1-7) I AM I/any portion of the residential structure or the land not exceeding one(1)acre that immediately Burr••nds t =l structure is used to produce income,describe the use and portion or the property utilized to produce income G — -\ --_O Z.—o oLk - g\\ -D PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County.and Township Is c i nt vacating a homestead? Yes ❑ No Signal of aimant I hereby certify the above statements are true,correct,and complete. / Address of contact(number and street.city,state.and ZIP code) Address//vacat-• estea mber and- eft 't.state,and ZIP code) '. S ' S� • �r1 2- uht u`DT\\ ‘ • its , ASSESSED VALUENON-RESIDENTIAL I HOMESTEAD VALUE ASSESSOR USE ONLYVALUE Land not exceeding one(1)acre immediately (1) _i..•- __ ~, s . I surrounding residential Improvements �;> �}\9 Other land (2) - —, I _ Total land(line 1 plus line 2) (3) 1 Residential impro en• •r Dwelling (4) O annually ass bile — -- ,W _� ` • manufacture a Garage (5) © er Pro (6) _- t; Q ovements(Ii el�through line 6) (7) I otal value"'' (fiat£IIk4ine 7) (8) A 1 Signature of Assessor Date signed(month,day,year) -�,� Ind co�e`i!Ite. the above s tr t. and co ln- r _ ( Verifyingaction-Si t • di Date signed(month,day.year) gna y/t)gC� STANDARD DEDUCTION ALLOWANCE 20_4:w\0 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. Notwithstanding`ta any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S that is not assessed as real property or to a manufactured ho of assessed as real property may not exceed one-hal 1 of sassed value of the mob' h e nufactured home. ` Signature of Auditor \+l� , 'ae.� Da9n�(rryonth da�ypar) . DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxp l/V— l(/�^f Page 1 of 2