Homestead_Hunt (8) • CLAIM FOR HOMESTEAD PROPERTY TAX
�'.A. L
YEAR
tirlSTANDARD/SUPPLEMENTAL DEDUCTION FORM
� State Form 5773(R18/1-20) HC10
•-• .• 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 ere confidential under IC 6-1.1-12-37.
n_\ �1J. CERTIFICATION STATEMENT
`I(We) • OLkn Ro0els "RAJ') certify that I(we)occupied as my(our)principal
place of reside�de o am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Dedu tion is hereby claimed on the date this application is signed, (date of signature). I(We):
Own. ❑ Am(are)buying under recorded contract.
(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.
1 ❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township ii
g d• •ct( 'y tc.5" r,:.-sn,q,)_�
o-sc> .
,Parcel num er Legal description Is 1 operty in question
cal property ❑ Annually assessed mobile home(IC 6-1 1-7)
t If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrou stir structure;s used to produce income,describe the use and portion J
of the property utilized to produce income
2 G — 1- IG - Ia0 -10 - i SI -0Z9- -
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Slate County and Township Is claimant va g a homestead?
1 ❑ Yes No
Sign re of Gaiman -~
I I hereby certify the above statements are true,correct,and complete.
I Address of contact(number and street,city state.and ZIP code Address of vacate omestead.d (number and street,city state.and ZIP code)
. 4 w $b S P)-toY\—,_Yv\- ?"6 MV . I
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately ,{, >
surrounding residential improvements (1) 3',r, ...4,se;' ,..�.+-a
Other land ;.e, , * AK*
f
Total land(line 1 plus line 2)
Residential improvements or Dwelling ( 1��3 fir& : } o ,
annually assessed mobile I (3
manufactured home Garage (5) �� O� AININININNIIIM
Other improvements (60 "'' tilt s
total Improvements(line 4 through line 6) (7) /] Y'PQ\1
Total value (line 3 plus line 7) ) •�1L (VVN1y
I hereby certify the above is true,correct, ""eCscr I Dare signed(month 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 S45,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1 1-12 to a mobile home S
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 va`viki mobile home or manufactured home.
Signature of or .� k. -- 1 ate si• ed(ma ay. ear}, \ •
DISTRIBUTION: Original-County Auditor.File-- mped ••y-Taxpayer
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