Homestead_Mattingly i • . CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
i . . 'F STANDARD/SUPPLEMENTAL DEDUCTION HC10
State Form 5473(R181 1-20)
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
r .
I(We) I eys /e f -,---1./ certify that I(we)occupied as my(our)principal
place of residence or a (are)buying the following desc .d ::I property under contract for which a Homestead Property Tax Standard
De, ction is hereby claimed on the date this application .ig d,
X (date of signature). I(We):
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.
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city town,township)
on �2
Parcel number \ Legal description I Is the property in question.
j ❑Real 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.
�6 - ICI- 3s -400 —C 2 - LI — O2—k
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is claimant vacating a homestead?
❑ Yes 0 No
ign of imant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state.and ZIP code) Address of vacated homestead,if any(number, d e state,a Z code)
�1025 L Whi g ik . --�0 0� -,.n- ►. — \r) —
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL _\I v
I 9 I IQ
VALUE I
Land not exceeding one(1)acre immediately (1) :rig - sr t 'i ?' '
surrounding residential improvements r—..
r
Other land (2) }, p '::1:(
d`J
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) O ni si ` `
annually assessed mobile/ A - � 5�
manufactured home Garage (5) ,
Y
Other improvements (6) �sO 7 74 $E?� ,: ..'.
11.
Total improvements(line 4 through line 6) (7)
4,
Total value (line 3 plus line 7) (6) G� O��
Signature of Assessor 2�{- * Date signed(month.day year)
I hereby certify the above Is true,correct, �+a
and complete. (/
Verifying action-Signature of Auditor / -? Date signed(month,day year)
p4,
STANDARD DEDUCTION ALLOWANCE
20- pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
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 h t assessed as real property may
not exceed one-half(1/2)of the assessed value of the mo a home m ufactured home.
Signature of Auditor Date sign d(mo day.year)
....,/DcAlt..\
\v-\ NI h 1,02 ) .
DISTRIBUTION:Original•County Auditor,File-Stamped Copy-Taxpay
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