Homestead_Wilcox (2) e'":koit CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I
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iii ) STANDARD/SUPPLEMENTAL DEDUCTION FORM
,r State Form 5473(R19 I 1-23) HC 10 ^/3
�r.r.i� Prescribed by the Department of Locai Government Finance
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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.
t CERTIFICATION STATEMENT
I(We) � QT.\INA- W l COX certify that I(we)occupied as my(our)principal place of
residence or am(are buying the followin described real property under contract for which a Homestead Property Tax Standard Deductions hereby claimed on the
date application is signed. la/alS/P/3 (date of signature) I(Wei
Own ❑Am rare)buying under recorded contract
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
0 Am(are)the shareholder,partner,or member of the entity that or.r s the property
if Buying on Contract.Fee Simple Owner's Name
Recorders Office Nfiere Contract is Recorded I Record Number Page
PROPERTY DESCRIPTION
County Township - - - 'win.township)
G%bSov OZ > . vi..°et
Parcel Number Legal Description is the p perty in question .
/G-1 V i9—100— 00R. L l-\7^Q^p[5 Real Property 0 Annually Assessed Mobile Home(IC 6-1 1-7)
If any portion of the resdential 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
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township /!(���w 1.. �� ) ��.�y Is Claimant Vacating a Ho esteado
�tL iL "kr S V/T W/•1' ( -- - 1 El Yes o ---
_----i
I hereby certify the above statements are true correct.and complete 16, - ) _ s`L
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Address of Contact("lumber and street.city state and ZiP de) Address of:acated-cr^estead if any(number and st city.state and ZIP coded
001J a en50 V2. •
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ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement ______ _ _ __ __ -,_
Other Land (2)
Total Land(line I plus line 2) (3)
Residential Improvements or Dwelling (4) TALEA)
Annually Assessed Mobile/
Manufactured Home Garage I(5)
I + — i
Other Improvements (6) DEC 2 1 Vi 1 [ZOn3
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor ��-fh r __/ ��I la,�rfilrl nth years
I hereby certify the above is true,correct,and complete. / /�/1 LutOUNT�( AUD1 ,-
Ventying Action-Signature of Auditor }$�OAL� 'Date Signed(date month.year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 548 000
Notwithstanding any other provision.the sum of the deductions provided in IC 6-1 1-12 to a mobile home that S
is not assessed as real property or to a manufactured home that rs not assessed as real property may not
exceed one-half(1/2)of the Aassessed value of the mobile home or manufactured home
Signature f Auddol , Date Signed(month.d , -
DISTRIBUTION: Onginal-County Auditor File-Stamped Copy-Taxpayer
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