Homestead_Robinson •
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
it.'t it STANDARD I SUPPLEMENTAL DEDUCTION) FORM
ME:
iiessiv)1 State Form 5473(R18/1-20) HC10
•'-----e 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 1C 6-1,1-12-37.
CERTIFICATION STATEMENT
I(We) ( it IOA IV) 0 14-sti i\- certify that I(we)occupied as my(our)principal
place of residena or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Ped,ction is hereby claimed on the date this application is signed,
ri
Own. 0 Am(are)buying under recorded contract.
Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. (dote of signature). I(We):
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
El Am (are) the shareholder, partner,or member of the entity that owns the property.
)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
- PROPERTY DESCRIPTION
County Township
Taxing district(city town,township)
Parcel number S ..S°4 .
Legal description 0 VI- •
Is I e operty in question: _
Real property El Annually assessed mobile home(/C 6-1.1-7)
1
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrou s t t structure is used to produce income,describe the use and portion
of the property utilized to produce income
aL-01-5 7 -\-2:4-- oo0 . 0 ---g - 01-4- •
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Stale,County.and Township Is claimant va at' g a homestead?
El Yes No
Signature maw
I hereby certify the above statements are true,correct,and complete.
/
Address of contact(number and street,city,state,and ZIP code) Andre cated ho stead,if a y(number and street,city,state,and ZIP code)
5 lt42, E—S R. 5 6 IA 4-047-.3n- 1-0-614-0
.ASSESSOR USE ONLY I ASSESSED VALUE ' HOMESTEAD VALUE NON-RESIDENTIAL
VALUE'
Land not exceeding one(1)acre immediately
(1) VkiMis...1"i9-1(411;40;
surrounding residential improvements .1,:-..,..-S,,, ,,te-41,;.`:..•.tbt:,-,VAEG%-. .•
Other land 1p, (2)
a.. 41..V.I.P.4tv:WallANI4I.Iaa -'44iq
Total la .--(fine .,u ine 2) (3)
,..,
Re identi:10•vements or Dwelling (4)
Vitiftrfl-lf•t'r'-
',"/II/-,1, .:.,c Watfe,,,WS1/4fIIM.,3&,
n ally -;", sed mobile/
an c ed home ef),N Garage (5) -0-rati-A'VAW$°43-' 4
Ot improvemknts %.*kop.i.
0045)._(6)
otal imprViants(line 4 t ou tft- (7)
ii;:141i7.
Total*Vine 3 plus line vzScg. (8)
Signature of Assessor Date signed(month,day.year)
I hereby certify the a.oaiK&e,correct,
and complete.Sand
Verifying action-Sig I -cp.rditor
(3‘ Date signed(month,clay.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 S
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed valu mobile home or manufactured home.
Signature of Auditor
PlOOkitn.' -5 Date sign d(month,daif year)
3
DISTRIBUTION: Original-County Auditor,Fite-Stamped Copy-Taxpayer
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