Homestead_Gogel . . .
',... CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
!I.1
A. STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R18/1-20) HC10 70 2-3
Prescribed by the Department of Local Government Finance
hVSTRUCTIONS: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
.
1(VVe) NM kni-Hlrin 410t." ' . certify that I(we)occupied as my(our)principal
place of residenc-or am(are)b. i g theikliog described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date -s application is signed, (date of signature). I(We):
0 Own. 0 Am(are)buying under recorded contract.
D 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.
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township 02 A TaxierdTiTrict(cif town,township)
Parcel number
Legal description • *---\° 1110.1() .
Is e roperty in question:
Real properly El Annually assessed mobile home 1/C 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrau s at structure is used to produce income,describe the use and portion
of the property utilized to produce income
# (:, 0-- I
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is cl-'• ant vacating a.°mei-ad?
TA Yes D No I VC , ',s JAP ley c CI)
Si n ture of claimant
1 l
I hereby certify the above statements are true,correct,and complete. '
LAI-. btit-t id, I • a 0 bb
Address of contact(number and street.city.-1).and ZIP c.de) d ess of vacated hom ead,if a y(numb'.irV ad street,city.state.
_L_ d Z11=code)
9-31k LOComA,61 -,f w , NN .
ASSESSOR USE ONLY ASSESSED VALUE
1 HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2) '
Total land(line 1 plus line 2) 1(3)
. . .
Residential improvements or Dwelling (4)
annually assessed mobile I
manufactured home Garage (5)
Other improvements (6)
\
\SS)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
,,\SC4.
Signature of Assessor cf., Date signed(month,day year)
I hereby certify the above is true,correct,
and complete.
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 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 v ,-, , ,mobile home or manufactured home.
Signature
Qa @ _.
)r)-- • Date sign d(mon ,day year)
DISTRIBUTION:Original-County Auditor,File-Slam.•.*.py•-Taxpayer
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