Homestead_Bain d�.=+S.a CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
HC10 oZa
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/C 6-1.1-12-37.
, CERTIFICATION STATEMENT
I(We) 7QI y IV Oat el 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, l i,Fvaa (date of signature). I(We):
L7 0`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.
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
CONTRACT RECORDED r�
If buying on contract,Fee Simple owner's name t 'f
'
Record number Page
Recorders office where contract is recorded
G �.7
PROPERTY DESCRIPTION
County Township Taxing district(city town,township) -
'1 G7i6Sp'1 Ur�(b✓t \ ��.
Parcel number Legal description Is the property
p��perty in question' yes `
•
^ —�^ l+stteal property ❑Annually assessed mobile home(IC 6-I.f-
Pny p C n Ift-Yoo-�ct a 3�t i one()acreimmediately surrounds n\ _ •rr '
If any port of -e residential structure or the land not exceeding1 that its that structure is used to produce income,describe the use and portio�r.\ + (- r
of the properly utilized to produce income \v\ �`' a 7
^ ,/PROPERTY OWNED ELSEWHERE BY CLAIMANT l�\\J C�
State,County.and Township Is claimant vacating a homestead? /�
A ❑ Yes ❑ No -•VY
signat�bt'�i t ///n` ` - — �`
I hereby certify the above statements are true,correct,and complete. ( ,...
•
Address of contact(number and street.city.state.and ZIP/ code) Addres vacated estead,if any(number and street.city state.and ZIP castle) \tr y
7e/ E Sez3 F, $r7c./ILI7 ✓" Li-761 A• NON-RESIDENTIAL
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE V.
r VALUE
•
•
round ng rresident al Impo e rm entsdiately (1)
Other lan•
d
(2) - - ---
Total land(line 1 plus line 2) (3) --
Residentialimprovementsor Dwelling (4) -_
annually assessed mobile/ Garage (5)
manufactured home --Other improvements (6)
•
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6) - signed(month,Signature of Assessor Date day,year)
I hereby certify the above Is true,correct,
and complete.
--- -- -- Date signed(month.day.year)
•
verifying action-Signature or.wehor
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 as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.�/A Date signed(mortar,day,year)
Signature Au kor /e /
/r o _ "ij /Or'✓ (/
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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