Homestead_Hill 1
,.,. CLAIM FOR HOMESTEAD PROPERTY TAX MEGELMII
FORM )
y° I. STANDARD/SUPPLEMENTAL DEDUCTION ORINE
111400. + Stale 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 IC 6-1.1-12-37.
I(We) certify that I(we)occupied as my(our)principal
place of residence or re ping the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby al ed the date this application is signed, (date of signature). I(We):
t-Own ❑ Am(are)buying under recorded contract. _mil
❑ 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.
❑
CONTRACT RECORDED
::::::::s:::t::::o:1:a::i::::me
wners namer::t t
recorded Record number Page
AM
PROPERTY DESCRIr'TIOA
Coo' ripir Township axing,Q(city. Q'nship)
I f .t.''''
Parc�er / L descriptio / 'Is the pr!'rty in qu lion /� assessed A... _. _
eal property ❑Annually a sed mobile home(IC 6-1.1-7)
-'-/ /y/ 1 . at immediatelysurrounds that structure is used to produce income,describe the use and portion
If any portion of the residential structure o �land not ex ing one( )
of the property u ized to produce income
,--- - [5 -- col -'o 0 - ) S1- 02-7
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacating a homestead,
❑ Yes ❑ No
Signature aimant
1 hereby certify the above statements are true,correct,and complete.
Address of contact(number and street.city state.and ZIP code) rirte-loni A ress of vacated ho ead.if (number ands reef city state and ZIP code)
�•
I. V(,t.CC • \=N 149101 D
ASSESSED VALUE HOMESTEAD VALI' NON-RESIDENTIAL
ASSESSOR USE ONLY VALUE
Land not exceeding one(I)acre immediately (1)
surrounding residential improvements — - -
Other land (2)
'4-- P
Total land(line 1 plus line 2) (3) iV rj41
Residential improvements or Dwelling (4) _ kY k�O 9
annually assessed mobile I Garage6
manufactured home g (5) G7es N 0�9
Other improvements O a