Homestead_Cox t
YEAR
CLAIM FOR HOMESTEAD PROPERTY TAX% ��
..�"�`•;;� FORM
All STANDARD/SUPPLEMENTAL DEDUCTION HC1Q
a' 1. State Form 5473(R18/1-20)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for Ming 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) William Joseph Cox,Life Estate 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 is hereby claimed on the date this application is signed, (date of signature). I(We):
Own. El Am(are)buying under recorded contract.
CI Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
•
CI Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
C Am (are)the shareholder, partner, or member of the entity that owns the property.
CLAIMANT'S INFORMATION
If buying on contract,Fee Simple owner's name
Record number Page
Recorder's office where contract is recorded
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Gibson Owensville Owensville
Parcel number Legal description Is the property in question: a
CC
Real property Annually assessed mobile home(/Cilln CC
26-1 7-0 1403-000.334-022 HILLCREST 2 RI Real desu be brie use a w. n
6 any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income, �. y
of the property utilized to produce income. C 1.4
N
C+7 ♦-
' C,11 lvV Z
a PROPERTY OWNED ELSEWHERE BY CLAIMANT C
__ C U
State,County,and Township Is claimant vacating a•homestead? Z
Yes ITV tvo r T 0
401 W Crestview,Montgomery Township Faja.4 m
CD
Signature of claimant
I hereby certify the above statements are true,correct,and complete. '�,�� -, C
Address of contact(number and street.city,stare,end ZIP code) Address of vacated homestead,'any(number and street,city.state.and ZIP code)
VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
ASSESSOR USE ONLY ASSESSED VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential Improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or DwellIng (4)
annually assessed mobile f IF Garage (5)
manufactured home
Other improvements (6)
Total Improvements(line 4 through fine 6) (7)
Total value (line 3 plus line 7) (a) Date signed(month,day,year)
1 hereby certify the above is true,correct,
Signature of Assessor
V
and complete. Date signed(month,day,year)
A
erityn. 5.natureefA Auditor I! -23—
L. i it
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
y° Notwithstanding any other provision,the sum of the deductions provided in IC 6-I.1-12 to a mobile home $
that is not assessed as real property or toe manufactured home that is not assessed as reel property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home. Date signed(mortm.day,year)
, Signature of Auditor
DISTINS N: Original-County Auditor,File-Stamped CCoppyy-T�axpayw
Page 1 of 2