Homestead_Duncan (2) 4' GLAIMSTANDARD FOR/HOMESUPP SL TEADEMENTAL PROPERTY DEDUCTI T ONAX% ��
s State Form 5473(R16 FORM
/1-20) HCRU YEAR
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
�W I(We)Panda I t t V\ S 9r(i1 lb Vn CO.4' certify that I(we)occupied as my(our)principal
place of residence or a (are)buying the fo wing described real property under contracLfor which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, la,(0/a of (date of signature). I(We):
Diel(---)wq. 0 Am(are)buying under recorded contract.
0 Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
0 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 district(city town,township)
� ,IbSov1 7pt+oKos 7oN/✓►3)1ip FILEDParcel number Legal description Is the property in question:
616-f a-I c- o- cv1- !ci 4-ci.'7 property 0 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 rim-6
2022 of the property utilized to produce income. L/C(� b L LL
Afie-11-4-el a... r)
PROPERTY OWNED ELSEWHERE BY CLAIMANT Y AUDITOR
State,County.and Township Is d - nt vacating a homestead?
• �es
Sig claimant /j'''0 No
I hereby certify the above statements are true.correct,and complete. `f�/
Address of contact(number and street city state,an, /Pcode) d�C dress of vacated homestead.if any(number and street city state,and ZIP code)
ay .6 ' t 5 R Ca r i . , —1. _ b `7 s 8b(..../ Pr Le fort .L.A✓ G176 70
• ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL �
VALUE
Land not exceeding one(1)acre immediately (1)
•
surrounding residential Improvements _
Other land (2) - 1
Total land(line 1 plus line 2) (3)
• Residential improvements or Dwelling (4) -
annually assessed mobile/ -- er----
manufactured home Garage (5)
Other Improvements (6) V_ _
Total improvements(line 4 through line 6) (7) 0
Total value (line 3 plus line 7) (8) Cl)
1 hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day year) 6
and complete. _L---
Verifying action-Signature of Auditor Date signed(month,day,year)
8 STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. 1/41-1
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that i5 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. (N".r
Signature of Auditor ` �te'......--- Date signed(month,day 1
44)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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