Homestead_Barger CLAIM FOR HOMESTEAD PROPERTY TAX I EAR 1
r .x.,�4 STANDARD/SUPPLEMENTAL DEDUCTION HCRp IO'Z C,tl
'� 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) I ib ill « - certify that I(we)occupied as my(our)principal
place of residence or am(are)b g 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, (date of signature). I(We):
XDQ 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
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Record number Page
Recorder's office where contract is recorded
PROPERTY DESCRIPTION
County /� Township OO �ITaxing dist""ri''c/t��/(/city town,township) _\ �
G
Parcel nurM�e ��Y/ Legal description - Is the propertyin question'.
❑Real property ❑ Annually assessed mobile home(/C 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 and portion
of the property utilized to produce income
•
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacdtjfyg a homestead?
❑ Yes --�// o
aignalure o/el)
I hereby certify the above statements are true,correct,and complete.r/X\ylll �L`�'({riman 1..)„.....".„
_� ..
Address of mCC omestead.if any(number end street,city,state,and ZIP rode)
Address of contact(number and street city state,and ZIP code) a 1 1 C�l A ..r1
NON-RESIDENTIAL
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE VALUE
Land not exceeding one(I)acre immediately (1)
surrounding residential Improvements /^\
Other land (3) - -:-- -Total land(line plus line 2) (3) ^� y�)
-- 9
Residential improvements
ovements or Dwelling (4)- ,r 1. (L!/>
annually assessed mobile I Garage (5) O
manufactured home
Other Improvements (6) V
•
Total improvements(line 4 through fine 6) (7) A. JO/,��
1., Total value (line 3 plus line 7) Si , \may p`
Signature of As p�.. Date signed(morn,day read
I hereby certify the above is true,correct, N G
and complete. @$� Date signed(month.day yeah
Verifying action-Signature of Auditor ON
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 manufac red me that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of e bile ome or manufactured home. - Date signed month. r year)
j signature of ` .� _ I I 0, ` -1 2 Z
DISTRIBUTION:Original-County Auditor,File-Stamped - ayer
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