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Homestead_Hughes-Bell 01-,•;,. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR,.Y STANDARD/SUPPLEMENTAL DEDUCTION FORM �} �' HC10 2-0 State Form 5473(R18/1-20) '? Prescribed by the Department of Local Government Finance INSTRUCTIONS:Se filing instructions. NOTE:Tete! t'ense,state identification and federal identification numbers are confidential under IC 6-1,1-12-37. ' p,j' ` CERTIFICATION STATEMENT 4:10)l,; J , ,,� ��" �,lii�` $ certify that I(we)occupied as my(our)principal ry .uying the folio •ng 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): Own. ❑ Am(are)buying under recorded contract. I❑ 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. S? - It buying on contract.Fee Simple owner's name Recorder's office where contract is recorded Record number Page PROPERTY DESCRIPTION County Township Taxing district(city,town,township) 00G. Parcel no er Legal description I,Is he operty in question: IReal property ❑Annually assessed mobile home(IC 54.1-7) It any portion of the residential structure or the land not exceeding one(1)acre that immediately sarro do t I structure is used to produce income,describe the use and portion of the property utilized to produce income. I l ,.� [ ,p IS \J PROPERTY OWNED ELSEWHERE BY CLAIMANT ) / _ cs q �}D 1(y{) ITi Is claimant c ng a homestead? 11_ �1! (�;10�+/ljrfy� ((6 [/(C��/%�"/}rh/0r/(jj�1rJD�/t ❑ Yes No �� r Sfgnatur-at claimant . W •l O.,. S +ti ni�j ,e,correct,and complete. 1 - LL., , !A L.' P At © ,,,C "��\� 'P code) Ad' of scale•homestead,if an (numb -I'd street,city,state,and ZIP code) (�� i I ASSESSED VALUE HOMESTEAD VALUE NON VAIIDENTIAL 0 O 1 �tt (1j � • �% '� agr ;ram . to �1 a (2) i'x :r,. +{rx �":+=firi:at•u y+� QbCF `\;;� �j -'`d'r:..if'al'^tr"3¢,"�as' .„ n ',e _. -L/ 3 r (5) .(4) 'I ✓ry INtglI ...': '§I sa.3ri>W. N ( try n n 6-.1 v i rFa . t ft (`/ �l ( i C 6 (7�i6 ON Cp C NTY e,"'""a Signature nature of Assessor To& +Dale signed(month,day.year) Dale 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 S 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 J� Date signed(month,day.year) \I'''''k'J''k— / iltN(N:\nA*D-..1 LA--:-..? — .2-0-2--- DISTRIBUTI N: Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 2