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Homestead_Williams CLAIM FOR HOMESTEAD PROPERTY TAX YEAR 4/.., STANDARD I SUPPLEMENTAL DEDUCTION FORM 80, ' State Form 5473(R18/1-20) ' HC10 a 3 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) ‘Vt.r oserkk "Pey.kon ER7.01)0,-, 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, VI Op-3 (date of signature). I(We): IfrOWn. 0 Am(are)buying under recorded contract. 0 Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 0 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. CONTRACT RECORDED If buying on contract,Fee Simple owner's name Recorder's office where contract is recorded Record number Page - PRoPERTY'DESCRIPTION County Township a k......._. :Taxing district(city.town,township) 61L304 9--',0 Lc- Parcel number Legal description Is the property in question: -ID-03-900-©b(. Vi 6-0-27 riIefproperty 0 Annually assessed mobile home(/C 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 produce income. PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County.arid Township Is claimant vIrMhomestead? 0 Yes 41 No ,-- 4 I hereby certify the above statements are true,correct,and complete. '15-‘1:,‘, Il All' r i...( ..,A ...or Address of contact(number and street,city,state,and ZIP code) Addre if acated homestead,if any(number and street,cit tate,and ZIP code) 3 Po e ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL • VALUE Land not exceeding one(1)acre immediately (I) surrounding residential improvements . . . . . , . . . Other land (2) , . . .. ,- ' . FIL Total land(line 1 plus line 2) (3) E Residential improvements or Dwelling (4) . _ . — .. - ., annually assessed mobile I manufactured home Garage (5) A P13•TO' : Other improvements (6) . - Total improvements(line 4 through line 6) (7) Total value (line 3 pits line 7) (8) °./)2,,eiziati a,pi4a,424) Signature of Assessor GIBS t signed month,day,year) Y AUDITOR I hereby certify the above is true,correct, and complete. Verifying action-Signature ofAuditor 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 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 Auditor Date signed(month,day year) Alzkc va „... .24„ _ ,„,---- it/to/A 3 DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 2