Homestead_Stevens (2) N.^—•? CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
O. STANDARD/SUPPLEMENTAL DEDUCTION FORM
e'er. State Form 5473(R18/1-20) HCIO p�
'-' ,�+ -''' 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) Keel \.6_'r.\'€-ee't 5 4r-e V r )S 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. IxW a•"=/ (date of signature). I(We):
mown. ❑ 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.
CLAIMANT'S INFORMATION
CONTRACT RECORDED
If buying on contract,Fee Simple ownef s name
Recordefs office where contract is recorded Record number Page
PROPERTY DESCRIPTION E D
County Township Taring district(city.town,township)
t b Sinn )-[0•vbSNed 1- i
Parcel number Legal description Is the property in question:
(e ^_3/0 Ye, —�" 'f 1 —0 E-Rest property [Ti Annually assessed mobile home(IC 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 use9(jrtio2 2 2022
of the property utilized to produce income
AUDITOR
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is claimant vacating homestead?
❑ Yes to
+Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city.state,and ZIP code) Address of vacated homest .if any(number and street.city stale.and ZIP code)
et
t 6`�of 9 aa...V" - NON-RESIDENTIAL
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE 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/
manufactured home Garage (5) _ -- _ ---
Other improvements (6) _.
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6) -_ -
certify the above Is true,correct,
Signature of Assessor Date signed(month,day year)
I hereby ple and comte.
-- Date signed(month,day,year)
• Verifying action-Signature afAuditor
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.
,. Signature of Audaor#1j a/ _ Date signed(month day.year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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