Homestead_Ashley (2) 1-.4, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
z � STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1e/1-20) HC10 2_RD
<+ Prescribed by tie 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 ri-1 1-1 T.37r
CERTIFICATION STATEMENT 1�,
I(We) /ryt.e....2 dif . I • / certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the follow/g described real property under contract for which a HomesteadPro�T{ nd(,rd
Deduction is hereby claimed on the date this a.plication is signed, (date of sig
nat I 1 LLU
"Own. 0. 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 qualifi lee r Slr!�+ 424)
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number i Page
I
PROPERTY DESCRIPTION
County Township Taxing di t (city.town.
�ship) `
Parcel number Legal description I Is the propen, question
�jy - 'J 2-—l_9 LReal property 0 Annually assessed mobile home(IC 6-f(-7)
III��` yy(Seeding
f"yv—
i if any portion of the residential structure or the land not 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
b ''/ L/ ( 0- 171063 .-000_ 070— 007
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County and Township Is daiman'g a homestead? I
I - ❑ Yes ►+No
l uignaturn of claimant 1
I hereby certify the above statements are true,correct,and complete. /�� r -,__....
vim: --
Address of contact{number and street.city.state and ZIP code) Address of vacated homestead,if any(number and street,city.state.and ZIP cods)
ASSESSOR USE ONLY . I ASSESSED VALUE HOMESTEAD VALUE NONRESIDENTIAL
VALUE
' Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling (4)
annually assessed mobile I
manufactured home I Garage (5) . ' - -
Other improvements I(6)
Total improvements(line 4 through line 6) I(7)
Total value (line 3 plus line 7) (8)
c)7 ,I hereby certify the above is true,correct, Signature of Assessor Date signed(month.day year)
1. and complete.
Verifying action-Signature of Auditor Date signed(month.day year)
\trNK%."
e N.)
Ate 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
° NO not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
`,,,' Signature of Auditor ,� Date sign d(mon ,day,year)
�'de"'' :?TRtBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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