Homestead_Leavens ..a -.. CLAIM FOR HOMESTEAD PROPERTY TAX J YEAR
/°l/ j STANDARD/SUPPLEMENTAL DEDUCTION FORM
y' State Form 5373(R18/1-20) _-
HC10
\` 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) T--' dr K C_( I ; Lc_Na eX-S.certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real propertylixnder c ntract for which a Homestead Property Tax Standard
Deduction�du is hereby claimed on the date this application is signed, (v—I ..—-7---7—._ (date of signature). I(We):
{S 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.
.
Recorders office where contract is recorded �/�' Recor•number Page
�� a Y//I- •
PROPERTY J=L.Crt:c'::OM
Court Township Taxing district(city town.township) �
ip-
Parcel number Legal description Is the prLosx,tly in question:
Real property ❑Annually assessed mobile home(IC 6-1 1-7)
It 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 and portion
of the property utilized to produce income
a. 'L-e -os - r1- dq 61- - -IQ 1-7 ,
.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacating a homestead?
❑ Yes ---.—r
gna ure t t
I hereby certify the above statements are true,correct,and complete. ill
Address of contact(number and street,city,state.and ZIP code) Address v—ted homestead.�(num city state,and ZIP code)
335'7 E. Q ie, Lit —7 . ' A
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceetling one(I)acre immediately (1) f„''-•
surrounding residential Improvements _ `.`
Other land __- (2) . .T
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) 4Rw" ',' .'i'v:
annually assessed mobile/
manufactured home Garage (5) MINO, _
Other Improvements (6) zit . ",,.fit." __ ``'. t
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (a)
I hereby certify 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 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 es real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day.year)
.:t� �- e Q Q .- _,_ u K �10— k u—Z.z.
DISTRIBCOON, Original-County Auditor.File-Stamped Copy-Taxpayer
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