Homestead_Hagan ...,- , CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
:4.'- STANDARD/SUPPLEMENTAL DEDUCTION
FORM
1 � State Farm 5473(R18I 1-20) HC10 20
,;,,-4° 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) 1 t . i ii ICAV\ certify that I(we)occupied as my(our)principal
place of residence or am(a - .uying 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, (date of signature). I(We):
❑ Own. D 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
County r � Township°2_/} Taxing district(city,town,towmsh•) {
in
Parcel number `\} Legal description {jj~} Is the property in question.
❑Real properly ❑ Annually assessed mobile home(IC 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 in me
2- -- I -2.,.m osi _2,0 \ -oo1 . gS
-
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant v king a homestead?
❑ Yes No
q t e of claimant l�
I hereby certify the above statements are true,correct,and complete. £'7/L J 11 Clt
Qj G" V
Ad.ess of c intact n be a street.city.slat d ZIP co• }} �., Address of vacated homestead,if any(number and street,city,state,and ZIP cede)
1t p t" (..• JY— IV . _.
ASSESSOR USE ONLY ASSESSED VALUE. HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately {1)
surrounding residential improvements . . .
Other land (2)
Total land(line 1 plus line 2) (3) t1)
.r�s
Residential improvements or Dwelling (4) ",4
." ,
annually assessed mobile/
manufactured home Garage (5) '
Other improvements (6) \Sd
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (6) I /'r O
- CP
I hereby certify the above is true,correct, Signature of Assessor ` i 4'� Date signed(month,day,year)
and complete. —tit SR)
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 deduction vided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufact a th is not assessed as real property may
not exceed one-half(1/2)of the assessed value of th mobile h me r manufactured home.
Signature pli rc 0..t. \ Da a sign c rfn . X Yea''1� r(�--
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer ll//"
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