Homestead_Doerner dSsM FOR HOMESTEAD PROPERTY TAX I FORM YEAR
I.Al_ N STANDARD/SUPPLEMENTAL DEDUCTION c�_ ^1
s '- State Form 5473(R18/1-20) HC'IO K)G. -
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-- ---. • 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) 'nN� eNnflek - 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):
0 Own. 0 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.
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CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Town
\s�iP 11 Taxing district(cdy tows�(w nship)
(A ��v' IeJrr` \`
Legal description 0(`>j
Parcel number \ Is the property in question.
`1 ❑Real property ❑ 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 use and portion
of the property utilized to income
NJ
PROPERTY OWNED ELSEWHERE BY CLAIMANT )
State.County.and Township Is c=i• ant vacating a homestead? .
T Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. ^�. Q
Address of contact(number and street.city.state,and ZIP code) Q. _ '
Address of_cared homestea any(number 3/r�traa - state.and ZIP code)' �f
3Y1
�i g$ S S' �� • .lS� S� L NON-RESIDENTIAL /' (A t_ oCD
ASSESSOR USL.DNLY ASSESSED VALUE I HOMESTEAD VALUE 1100 E
Land not exceeding tiae m acre Immediately (I) ��1 `
surrounding residential improvements -- -- y`-�(] a
Other land (2) -
-�-Total land(line 1 plus line 2) (3) __ -- (��
Residential improvements or Dwelling (4) V
WI - -. _ _ -
annually assessed mobile/
manufactured home Garage (5) �'('�
Other improvements (6) ` J `* - -
Total improvements(line 4 through line 6) (7) J Q
Total value (line 3 plus line 7) (8) 'Y/,+llf_/ R O
Signature of Asse o INA, Date signed(month,day year)
I hereby certify the above is true,correct, OVN-CY
and complete. G -.--_ -_
Verifying action-Signature of Auditor 1] iSO�� Date signed(month,day year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
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 l`o71r@ or manufactured home.
Signature r, \ `\N S t Date ai netl(r) da'
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DISTRIBUTION:Original-County Auditor,File-Stamped Copy- l-� )1 l \ /^ I t
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