Homestead_Stevens (2) P-17.-..,. CLAIM FOR HOMESTEAD PROPERTY TAX •• YEAR
4-411, STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(RIB/I-20) ' "— HC10 g 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) L i SC3i.... .3C,,,,cloe. 5+,R.v ens 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, 7/10/073 (date of signature) I(We):
ii<wn. u Am(are)buying under recorded contract.
E Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
El 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.
, ;-.. .... ..-....,,:-
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number I Page
PROPERTY DESCRIPTION,
County 1 Township 0 0 Taxing district(city.town.township)
• .
G oosoyl ,
0 e, l
Parcel number Legal description I Is the property in question
a6-ici-kl-to,a- ocoi. 0(,,- 00-7 i Eel<al property r] Annually assessed mobile home(IC 6-1.1-7)
I
lacy portion of the residential structure or the land not exceeding one(I)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 and Township Is claimant MP;a homestead? i
C] Ye 6, No
—
I hereby certify the above statements are true,correct,and complete. .
Address at of contact(number and street,city state.and ZIP code) I Address of vaii,ted homestead,if any(number and street,city state,and ZIP code)
c22 (sT I .30 ,s-1- o'lcAret ' -on,
ASSESSOR USE ONLY ASSESSED VALUE
1 HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one acre immediately .
surrounding residential improvements
1 Other land (2)
Total land(line 1 plus line 2) (3) 1 --- -- - .
Residential improvements or Dwelling (4)
FILT . .
annually assessed mobile I
manufactured home I Garage (5) ..
Other improvements (6) .
Total improvements(line 4 through line 6) (7) I kit 10 202
Total value (line 3 plus line 7) (5) I
fA t gnaure ossessor . ed(month,day.year)
I hereby certify the above is true,correct, Si -44.11.d
and complete. twasat4 COUNTY AUDITOR
Verifying action-Signature&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 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
Signature,of Auditor aktm...." Date signed(month,day.year)
AAA. 14 V 1/I lt,7Q 3
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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