HomeMy WebLinkAboutHomestead_White (9) «wr„ � CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I
?4 �^ STANDARD/SUPPLEMENTAL DEDUCTION FORM ®r y
« State Form 5473(R1S/1-20) HC1 O
4 •'• /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) • e!_in e. t/ ./�f ` � certify that I(we)occupied as my(our)principal
place of residenn ee am(are)buying the following described real property under contract for which a Homestead Property Tax Standard .
D duction is hereby claimed on the date this application is signed, (date of signature) I(We):
Own. D Am(are)buying under recorded contract.
❑ m (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
O Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
O Am (are) the shareholder, partner, or member of the entity that owns the property.
' ,. ' .. ,- '-• _
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number 'Page
PROPERTY DESCRIPTION
County /��1� 4(,,�, yc^ Tovnshhiip{l',n/�t�,,� p ��.,. Taxing dd'isstt/riict(city,town,township)
7.
Pa¢el number (Legal description V - - I Is the prop- !ion
r1 � I-
�p-JI.17-L/00,E co#- )Q_f { r Heal property L�Annually assessed mobile home(IC 6-I 1-7) ,
If any portion of the residential structure Cr the land not exceeding 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
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.county end Township Is claimant vacating a homestead?
❑ Yes
Sig ur of dai
I hereby certify the above statements are true,correct,and complete. oA,
Address of contact(number and street.city state,and ZIP code) Addre bf ca!ed homestead.if any(number an street,city,state.and ZIP code)I
ASSESSOR.USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL O
VALUE
Land not exceeding one(1)acre immediately (1) O j
surrounding residential improvements . , 777�tttYYY!!!
Other land I(2) �•r CV Q
Total land(line 1 plus line 2) I(3) 1 }
Cra
el—
_ feet Z
Residential improvements or Dwelling 1(4)
annually assessed mobile I k-,,,„ •( Q O
manufactured home Garage I(5)
•
Z
Other improvements 1(6) CO
JO
Total improvements(line 4 through tine 6) (7) , I CO
Total value (line 3 plrs tine 7) I(8)
r
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day.year)
and complete. }/G��}}/�J Oat
Verifying a '.n-Signature of Audit , ! i../✓� Date signed(month.day year)
6- 19-202-
STANDARD DEOUCTICM 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 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.
7rrefAuditor /, f4/7t/ Date signed(month,daz year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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