Homestead_Wilson (4) iiizi �! CLAIM FOR HOMESTEAD PROPERTY TAX FORM • YEAR
i&C STANDARD/SUPPLEMENTAL DEDUCTION
„I State Form 5473(R 19/1-23) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE Telephone,Social Secunty,driver's license.state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
7 .p CERTIFICATION STATEMENT
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I(We) P-7 e iN . 1 ` \C_e Li •( \ _certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the follovpQ9..d;gibed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed. V/ (R 1 11 (date of signature) I(We)
[n ❑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 properly
If Buying on Contract.Fee Simple Owner's Name
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Recorder's Office Whtlherree Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
C I, Tow hip Taring District(city.town.township)
`tom_ pry o\ 1 a,
Parcel Number Legal Description Is the property in question
eel Properly 0 Annually Assessed Mobile Hare(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
a b -- « - `� - 300 - 0o I s9$0- DLc,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati,n__g.,,aa�IHomestead?
El Yes sNo
Sign of Claiman AN.r. re
I hereby certify the above statements are true,correct,and complete
Address of Contact(number and street city state and ZIP code) d-a1n••ddress of Vacated Homestead. (num r and stye r,.state.and ZIP code)
I t 0 S l 050 is cold . a a �? _,n
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately j 1j
Surrounding Residential Improvement Other Land (2)
Total Land(line 1 plus line 2) (3) _PI
Residential Improvements or Dwelling (4) ._
Annually Assessed Mobile I
Manufactured
Manufactured Home Garage (6)
Other Improvements (6)
SEp
Total Improvements(Line 4 through Line 6) (7) i f'
43 d\
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Dat a .month.year)
I hereby certify the above is true,correct,and complete. /880a .
401.
Venfying Action-Signature of Auditor Date Signed(date..''Mr
quo
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000
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 - -
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Signature of Auditor Date Signed 'no h,day, ar)
•Cf\LP:-J)"\a I__s_ot, . ^'� `VV\
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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