Homestead_Brown as^a. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
}°ia , STANDARD/SUPPLEMENTAL DEDUCTION FORM ++��
�-/ State Form 5473(R18/1-20) HC10
' / Prescribed by the Department of Local Government Finance GG//
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.
�t CERTIFICATION STATEMENT
I(We) f•\&. Q W A «O. L 3 row(-\ 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— uc� is hereby claimed on the date this application is signed, if/ I./t¢fa. (date of signature). I(We):
E a' wn. ❑ 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.
-
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County, Township Taxing distract(city town,township)
G%No Sorg 00 (-)• .b:o._
Parcel number Legal description 1t•
Is the property in question,
a/t -vs-\O- 100
M-(At • q O0- / )C t{�Real property ❑Annually assessed mobile home(/C 6-1.1-7)
If any portion of the residential structure or the land not'exceeding_''eee one(1)1)acrev 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 vacating a homestead?
/�)/J ❑ Yes ❑ No
Signature f c Sign V
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street. ty.state,and ZIP■ code) Address of vacated homestead.if any(number and street.city state.and ZIP code)
i r e , Qr tC L Cl mk J-
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements _ialiii ___
Other land (2) _
Total land(line 1 plus line 2) (3) ,,,,,,,,������
Residential improvements or Dwelling13 )
annually assessed mobile/ S l
manufactured home Gara ( `irw y .
Other improvements ) q \��111/ /��
Total improvements(line 4 through line 6) `, {. r ,/ ,Y• - r-
\�t 20 Z l)?t ° _ Q �Y Pups SCR
Total value (line 3 plus line 7) �;OUN
I hereby certify the above is true,correct, Signature or As ,t.y) O\$�O Date signed(month,day yeah
and complete. 'j�� `,�^^'-
Verifying action-Signature of Auditor .sj�r tl"" O`N'�V AvO,t OR _ Date signed(month,day.yew)
"STANDARD DEDUCTION ALLOWANCE '
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
i 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
nottt exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
1 Si natu of Auditor doptid Date signed(month.day year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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