Homestead_Schafer (17) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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Sj , STANDARD/SUPPLEMENTAL DEDUCTION FORM a�
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 lC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) Kevi Zi^ V.A. 5 e.ka fer 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
_D_edduuction is hereby claimed on the date this application is signed, (I(%b�e7a (date of signature). I(We):
i,i O,Nn ❑ 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.
D Am (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contract,Fee Simple owners name
----- - Record number Page '
Recorders office where contract is recorded
PROPERTY DESCRIPTION
County Township Taxing district(city town,township) ,
G• PSOa. y. • - - /
Parcel number Legal description Is the pr•perty in question,
//pt`_a7-400-00 4f• 815_ O�1^�- //_ rifled property 0 Annually assessed mobile home(/C 6-1.1-7)
IF% pol(ioon f the residential structure or the land not exceeding one(1)acrethat 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
Is claimant vacating a homestead?
Slate,County,and Township
w Yes ❑ No
sgn e of claimant /1 r
I hereby certify the above statements are true,correct,and complete •
��-,-.` - ' ' 7
Address of contact(number and street city state,and ZIP code) Address of vacated homestead. l ny(number-nd stre , rty state.and ee4e)
17 G e- 7."F4- - P I ce{-On •N 5' 1[4e' / NON-RESIDENTIAL
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2) Millni I 1111
Total land(line 1 plus line 2) (3) - -
Residential improvements or Dwelling (4) --
annually assessed mobile I NOV 1 0 202
manufactured home Garage (5) N
Other improvements (6)
Total improvements(line 4 through line 6) (7) r - razl it ; 'im`y
ON COUNTY AUii►TOR
Total value (line 3 plus line 7) (8) IRS Date signed(month,day year)
I hereby certify the above is true,correct,
Signature of Assessor
and complete. Date signed(month,day,year)
Verifying action-Signature of Auditor
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 ho t not assessed as real property may
not exceed one-half(�'jj\\//��)of the assesse Glue of the mobil home r anufaclured home. I Date sire( past a.v4 i
Signature of Auditor _ I`/rv, ('I`^� y
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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