Homestead_Estes ,s,;v'ty; CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r 1 STANDARD/SUPPLEMENTAL DEDUCTION FORM
ItitpState Form 5473(R18/1-20) HC10
-4• ,--, Prescribed 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
I(We) (�(\ t^:, 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, t$ -' Li-&.3 (date of signature). I(We):
IOwn. ❑ Am(are)buying under recorded contract.
E 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.
0 Am (are)the shareholder,partner, or member of the entity that owns the property,
Social Security number of claimant's spouse(last five digits) Driver'-a lose T dentitication I other number of claimant's spouse(last five digits) Issuing State
(App =bl only if:Pee: is spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name _ ._
Recorder's office where contract is recorded ) Record number Page
PROPERTY DESCRIPTION
County 11 ��"'� To' p , Taxing district 'Mr sh';t
,...i f OP ' c,... . -,-1k,.
Parcel num er Legal description ' Is the prap� ci;es'r,.:
eai property r;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'.produce income,describe the use and portion
of the property utilized to produce income
( - --O-7 —. \O -- QoA . c \--k -0
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,co ty.and Tolvmship Is claimant vacating a homestead?
\ "t ���r�irf\ 1 (t_ x� � 0 Yes XNo
t '��,�J/ 1 4-)11 Signature sooffclaimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street city state,and ZIP code) 1 Addr of vacated homestead,if any(number and street,city,state,and ZIP code)
1 6 f =t�l• . all,
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately COp-..,.. .. . .... ._,_ .„,,.. _
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) y�
annually assessed mobile 1 Al.`"4'
. 41).
manufactured home Garage (5) qq
Other improvements (6) e90 I �e2
Total improvements(line 4 through line 6) (7) NCO
vo
Total value (fine 3 plus line 7) (8) ��r�
I hereby certify the above is true,correct, Signature of Assessor Date sign,ye
and complete. 0R
Verifying action-Signature of Auditor Date signed(month,day,year)
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 1C 6-1.1-12 to a mobile home $
that is not assessed as real property or b 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 Auditor Ott \3�l} f`(1 Date signed(month,day,year)
.....r.i)
1/4,,,Air...„\sasiD .
DISTR\ Original-County Auditor,File-Stamped CopyTaxpayer }
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