Homestead_Zenthoefer .0-...t,, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
.1,1/..". STANDARD/SUPPLEMENTAL DEDUCTION FORM
144. State Form 5473(R18/1-20) HC10 202a,
.,.. ,i.,.,,,,- 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) Lee- 4. ' 0 r.Q.ANc 7..e,r‘ 4-'t- o- e,r certify that I(we)occupied as my(our)principal
place of residence or am(are)buying 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):
0 Own. 0 Am(are)buying under recorded contract.
CI Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
CI Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
If buying on contract.Fee Simple owner's name
Recorders office Inhere contract is recorded Record number 'Page
PROPERTY DESCRIPTION
County Township Taxing district(cit.town,township)
-*k CO-g-t\N\
Parcel number Legal description i Is the property in question
, 0 Real property 0 Annually assessed mobile home(IC 6-1 1-7)
I
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 ponies
of the properly utilized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County and Township Is claimant vacatingestead?
1 n Yes .‹o
....- Signs a f claimant
I hereby certify the above statements are true,correct,and complete. 1), /-
....
Address of contact(number and street.city state,and ZIP code) i Address of vacated hum ad.if any(num nd street.city state,and ZIP code)1
+11h
a) * 'A., ,A • . .t.:- '
ASSESSOR USE ONLY
I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
I Land not exceeding one(1)acre immediately .. .
surroundin.residential im.rovements (1) 11111111L 2 • : . ' • :•
Other land (2) ,ifi• ••_amemni
11==111MM111111111111111M
Residential improvements or Dwelling I(4) 4
annually assessed mobile/
manufactured home I Garage (6) 1 ,oe MIME=
..,,
Other improvements I(6) •I Gia 79/11111111111111 ab-411101.111111111111111
Total improvements(line 4 through line 6) (7) ' I
CO ... "Ill `'''"la
11115= 3fl7Il3111111111111110 1
Signature of Assessor 'a/Wed(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 borne that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor s Date signed(t) h.day.year)
\
haoklik \Ails 4 ' ii a, . 1
4..
D1STR113UTIO •riginal-County Auditor,File-Stamped Copy-Taxpayer
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