Homestead_Houchins (4) of
^At, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
471.1t STANDARD / SUPPLEMENTAL DEDUCTION FORMo ^O��
State Form 5473(R18/1-20) 04
° ° 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) A ticord. A-ACNION:f',,N �or\n oL La\Ic 1( certify that I (we)occupied as my(our) principal
place of residence or ani(are) buying the following described real property under contract for which a Homestead Property Tax Standard
Deductiondu is hereby claimed on the date this application is signed, —1 -31- CD3 (date of signature). I (We):
L�'Own. ❑ 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 qualified personal residence trust.
❑ Am (are) the shareholder, partner, or member of the entity that owns the property.
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Comte
Parcel number Legal description Is the prol:,Whin question:
1 PWAreal 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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
1
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,
,aand
d Township `� l 1 0 /� (� ,/ Is claimant vacating a homestead?
P \C�-f ' Q a )-I n` j 4 JJx.1J-7`L, . Yes ❑ No
Signature of claimant / /f CD
hereby certify the above statements are true, correct, and complete. � c>4jZ L"
Address of contact(number and street,city,state,and ZIP code) Addre of vacated homestead,if any(number and street,city state,and ZIP code) )
•1s_:i
. V-r CLr\CL� c
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL j-�
VALUE v
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements N
Other land (2)
(
Total land(line 1 plus line 2) (3) �� rJ
C).
Residential improvements or Dwelling (4) 1,��'�\-. 3"?../: 00
� -4-(
annually assessed mobile/ �.
manufactured home Garage (5) 0- )
3,J ,o
Other improvements (6) a/N,C,t P
Total improvements(line 4 through line 6) (7) ..�� GOv
Total value (line 3 plus line 7) (8) l�'\gON
Ihereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE