Homestead_Singleton (4) z.r.^YI
4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORM
lo
State Form 5473(R15;1-23) HCIO L.V .
�.,- 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(eye) '0 WIF iv.- rw N certify that I(we)occupied as my(our)principal place of /
residence or am(are)buying the follow I.described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the Zabo.A±to s application is signed. (date of signature) I(We)
n ❑Am(are)buying under recorded contract So•1
(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
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Mere Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County /-^ \ f� Township O ��_ Taxing District(city,town,township)
/l5- o,r\ to
Parcel Number Legal Description th property in question
eal Property 0 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 surro ds t structure is used to produce income,describe the use and portion
of the property utilized to produce income
a6 - IO -Zoo - 002 . 505 -02)
PROPERTY OWNED ELSEWHERE BY CLAIMANT I
State,County.and Township is !aim nt Vacating a Homestead?Q D�• O
No 0.0
p Signature lalmant /r 'TV Yes
�g.411A r\IVej/t ►)1
I erPhV certify the above statements are true,correct,and complete !� AO. " � ` (
�Address on=act(number and street.ci rate and ZIP code) Address o Vacated Homestead.if any number and street city.state and ZIP code)2 ) U!�
otu � bY�-�n y�bu I16 '� EGodSyC-fit �ncl.,-�- �64� 0
EG F 1 „VA
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE � U
Land Not Exceeding One(1)Acre Immediately 8 S `�, aL"��r(,
Surrounding Residential Improvement_ _-� V 11 n
Other Land (2 F
Total Land(line 1 plus line 2) 0 iin 1
Residential Improvements or
e 1 4> LO "
Annually Assessed Mobile/
Manufactured Home rage �.(( \ `.eL% O
N LC �t 0
Other Improvements c§..,\ (6) V \ (Q,�p,
Total Improvements(Line 4 through ' 6) (7) //77 O\,1QQ 1 �S S J("`
Total Value(Line 3 plus Line 7) ,.(� P`� �` '
e of Assessor Date Signed(date.month,year) Ti J
I hereby certify the above is true,c r t o A ,- t/.�vr`
I
Verifying Action-Signature of Auditor kA Date Signed(date.month,year) �''t'`6 C'1 .
STANDARD DEDUCTION ALLOWANCE IN I
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000 tOk \A
Notwithstanding any other provision.the sum of the deductions provided in IC 6-1 1-12 to a mobile home that $ U
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 manufac me I
Signature of Auditor Date 51gne (month. a year) 1 19 IrQZ
to Ict
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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