Homestead_Helm ,11,7N, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
/'.. '.4.\.___ANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473 OR 15/1-20) HC10 0)3
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.
CERITFICATION.STATEIVIENT
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I(We) et•eyr-4- \N) 14 ei„, 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):
53‹-/Wn. 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.
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Recorder's office where contract is recorded Record number 1 Page
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PROPERTY DESCRIPTION
County
I C7k\z>son Town : -
Taxing district(city.loan,township)ship 0 2
P
Parcel number i Legal description i he pr _rty in question
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(96r1)-((s*—I Ot'epi•C3'".WI -1 i Real property 0 Annually assessed mobile home(fC 6-1 1-7)
!If any proton at the residential structure or the land not exceeding one(1)acre that immediatety surrounds th . !mature is used to produce income,describe the use and portion
of the property utilized to produce income
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
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State.County and Township
Is daimant vacating a homestead?
E Yes 0 No
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I !.Ard5lat0EPT4Driao
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city state.and ZIP code) Address of vacated homestead. any(number and attreet city stale bid ZIP code)
, 575 Atoodowl. r-,e-- Ni. . W\c.c..e,- 0 _.1.-v H 02
ASSESSOR USE ONLY
I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
.. _ .. ,
I Land not exceeding one(if acre immediately
1
surrounding residential improvements (1) '
I Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling 1(4)
annually assessed mobile I
manufactured home Garage 1(5) . . . . .
Other improvements 1(6) MAY
Total improvements(line 4 through line 6) 1(7)
Total value (line 3 plus tine 7) 1(8) 9 2823
4Adutti a 4igwrd461m4),vrvITOF
1 'Signature of Assessor GIBSON COLM I.TeXcts.th. ay.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 5-1,1-12 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(1/2)of the assessed value of the mobile home or manufactured home.
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Signature of Auditor/yik ... 421,..,,,,,,,,,-- Date signed(month,day,year)
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DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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