Homestead_Brown (35) C ; CLAIM FOR HOMESTEAD PROPERTY TAX FARM YEAR
Alit`'� STANDARD I SUPPLEMENTAL DEDUCTION R
' State Form 5473(RIB/t-20) HCSM '.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.
CERTIFICATION STATEMENT
I(We) �C kOsin 1_11')1' l ' J '\ certify that I(we)occupied as my(our)principal
place of residence or am(•.re)buying the following described real property under contract for which a Homestead Property Tax Standard
eduction 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.
❑ Am (are) the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION
PROPERTY DESCRIPTION
County ,Of\ - Township (1 t'} Taxing district ',,town,townstri� _
Parcel number; Legal description Is th-•/needy in question:
ria -eat property ❑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 surrou l's the structure is used to produce income,describe the use and portion
of the property utilized to produce income.
1\`—' R --`2,, S -000 , Rg 2 - 0 2-S _.
PROPERTY OWNED ELSEWHERE BY CLAIMANT' N
State,County.and Township Is ai ant vacating a homestead?
Yes No G
9ature
of dolma t I hereby certify the above statements are true,correct,and complet . C""
Address of contact(number and stree.city,state:and ZIP code) Addres of vacated homestead,t any(number and street,city,slate,and ZIP code) L•
130 N (01 f 4.0,ti-Dv) - 44-6 1-0 13o - eT .i*w R 4 i'-bq -D 49-6 .3
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE Cili
Land not exceedingone.(1)acre immediately
surrounding residetial improvements (1} 3 rrx f�t't.'' �%3 ' ; ri
Other land (2) - `?��.��u,��,v4.u.:Ffr�:a
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) iti ti r t s^.. �v qi . "�—.
annually assessed mobile! �, t
manufactured home Garage (5) It '
� ���,
Other improvements (6) Y ,. ,.,,7 k `.l
Total improvements(tine 4 through line 6) (7) al e
Total value (line 3 plus line 7) (8) (j'}}j
I hereby certify the above is true,correct, Signature ofAssessc�St,� 0 Date signed(month,day,year)
and complete. 4/
Verifying action-Signature of Auditor CQej h4" Y (.....?,': ate signed(month,day,year)
`YQ ?'...
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
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 nufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assess d va u f the mobile home or manufactured home.
SigiJa_lure f Auditor Date sign (month, y,year)
DISTRIBUTION: Original.County Auditor,File- d Copy-Taxpayer
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