Homestead_Blake •
CLAIM FOR HOMESTEAD PROPERTY TAX
tr., STANDARD tt SUPPLEMENTAL DEDUCTION FORM YEARe� �� 22
�� Stale Form 5473(RI8l 1_20) HCIG Z 0 G.� .
•
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. .
NOTE:Telephone,Social Security,driver's ffcense,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) , `1 i alb ' . certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the foil.Wing 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.
m (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.
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 1 p Townshi Taxing distrct(city.town,township)
stirs o v>Z .
Parcel number Legal description Is t roperty in question:
Real property El Annually assessed mobile home(IC 6-1.1-7)
It any portion of the residential structure or the land not exceeding one(1)acre that immediately surroun s th t structure is used to produce income,describe the use and portion
of the property utilized to produce income.
C- Q2--1S - 3 ) -- 00"0 . 0 1 - 0 28 ..
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vaca' g a homestead?
❑ Yes No
Signs re of claimant 1
I hereby certify the above statements are true,correct,and complete. `----
Address contact(number and street,city,state,and ZIP code) •ddress of vacated homestead,if any(number and street,city,state,and ZIP code)
50S 1)a e `AVC 1fi0 n— 31)— tlib .=.
ASSESSOR USE ONLY ( ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceedingone(1)acre immediately " ? "
surrounding residntial iprovements (1} r -., -,,r.t. }ta. ..;,..s,i t,
Other land (2) ''.r,'9a,,,.'Nv,t r '° }-''}4
Total land(line 1 plus line 2) (3) x
Residential improvements or Dwelling (4) 4p. �'' k
annually assessed mobile I r74.7 ,,.as.. ip. -�e
manufactured home Garage {5} 11 (/ 4??T,t a "' s, .'k ="
Other improvements (6) j80. ,s'rx PK s p -il 1
Total improvements(line 4 through line 6) (7) ' 0 40111.
Total value (line 3 plus line 7) (8) 'Ir'�^
I hereby certify the above is true,correct, 'Signature of Assessor ''It ;J, e' Date signo-tmonth,day,year)
and complete. ',`7
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 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(V2)of the assessed value of the me or manufactured home.
Signature of Auditor R Date si ed(mo th,day,year)
ori
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Ta r
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