Homestead_Shoemaker (2) "4'1 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
si �� STANDARD I SUPPLEMENTAL DEDUCTION FORM
.r. State Form 5473(R181 1-20i HC10
,re 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 lC 6-1 1-12-37.
CERTIFICATION STATEMENT
I(we) (/�,fi r y oQ tQ r/Avbre) 6 A de ry a,Ke C certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the folio Ing described real property under contract for which a Homestead Property Tax Standard
Deduction/ is hereby claimed on the date this application is signed. 4(/30/ 3 (date of signature) I(We):
ICJ Own. ❑ Am(are)buying under recorded contract.
❑ Am(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.
❑ 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 of5ce where contract is recodeI Record nurrtei i Page
PROPERTY DESCRIPTION
County s Township I Taxing district(city town,township)
G‘\oSd�, — �ol�. a�ns
/ Parcel number 'Legal descriptor Is the property in question
Z.Aler%—Sao-66a$-1 i- Do) it pro a perty u Annually assessed mobile home(IC 6-1 I-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 descnbe the use and portion
of the property utilized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County and Township Is claimant vacating a homestead?
YesX'No
Sgnature o!claimant ' //\VCt/'n
I hereby certify the above statements are true.correct and complete n f - '
-- rIVVI//{'v/1A
Address of contact(number and street city state and ZIP code) I Address of vacated homestead if any(number and ,city slate,and Z/Pcode)'
/03'6)O 5kVA - Ca' 'Iti )t/- AG-v 4 ,.40. Lki‘ .`t
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential Improvements
Other land (2)
L
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling (4)
annually assessed mobile I 4O6
manufactured home Garage (5) V 2 i,
Other improvements (6) 023
Total improvements(line 4 through line 6) 1(7) _ I e`SO/v '� ��,� ‘
Total value (line 3 plus line 7) I(8) COUHryq
Ihereby certify the above is true,correct Signature of Assessor Oal�e�g/e)ty•
:.nth.day year)
and complete.
Verifying action-Signature of 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 to signed(month.day.year)
i 14- . kfiii\a.L.0 11- .\J3 00.--4-‘1, 1.Z. /I I k t A) , *- 1-1-cD .
DISTRIBUTE : Original-County Auditor.File-Stamped Copy-Taxpayer g
Page 1 of 2