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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 Page 1 of 2