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Homestead_Weber (2) •, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR Ai.-.7 STANDARD/SUPPLEMENTAL DEDUCTION FORM t' ' State Form 5473(R18/1.20) HC10 sue'. Prescribed by the Department of Local Government Finance t�'� 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. CERTIFICA't'ION STATEMENT I(We) ©`s C_t(ah i- U)(E'aQ i certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following des abed real property under contract for for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, —\("1 r'�t (date of signature). I(We): wn. ❑ Am(are)buying under recorded contract. ❑ 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. .- If buying on contract.Fee Simple owner's name Recorder's office where contract is recorded Record number Page PROPERTY DESCRIPTION + coon Township Taxing district(city,town,township) (-16'%\i:DSOY\ * '\ LjO ° 2,-,i( Parcel number Legal desc p on Is the property in question: 41,4<1;roperty ❑Annually assessed mobile ho a(IC 6-1.1-7) If any portion of the residential structure or the land net 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 a -\-, -C - Lk O o\ . rO-o PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County.and Township Is claimant vacating a homestead? ❑ Yes G�/`/No Si nature of claiman Li.... _ V I hereby certify the above statements are true,correct,and complete. Address of contact(number and street.city,state,and ZIP code) A dms f vacated omeslead,if anU(number and ssttreeet,,cpity state.and ZIP code) ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE Land not exceeding one(1)acre immediately surrounding residential improvements (1) Other land (2) Total land(tine I plus line 2) (3) _ :, , Residential improvements or Dwelling (4) r1 annually assessed mobile I �� manufactured home Garage (5) `,.'. Other improvements (6) t �d� Total improvements(line 4 through line 6) (7) a, pi ) cQR PO Total value (line 3 plus line 7) (8) !ryryN f.(�1��' Signature of Assessor 13rb`0ate signed(month,day,year) I hereby certify the above is true,correct, G� 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(12)of the assessed value of the mobile home or manufactured home. Signature of Auditor Date signed(month,day.year) 11 ,esQ (t \i -- n- Z3 DlSTRtN:Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 o 2