Homestead_Concannon '" CLAIM FOR HOMESTEAD PROPERTY TAX FORM
s; YEAR
STANDARD I SUPPLEMENTAL DEDUCTION 1 HC10 4�
's, -. State Form 5473(R 19/1-23) _ �O�
�lir/ Prescnbed by the Department of Local Cove,
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(We) Ph A►Its 4. Qf f(\(ja n 1O f,N_ certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the wi foll ng cri e rI property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
' date this application is signed. I — — c (date et/signature) I(Wel
,L-1,J.4, CI Am(are!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
O Ani(are)the shareholder,partner,or member of the entity that owns the property
:f Buying or Contract Fee Simple Owners Name
Recorder's Office'Abere Contract is Recorded I Record Number Page
PROPERTY DESCRIPTION
Counjt
,�.^^ Township - • .:%islnct(city town.township)O 2\
%,Vim[ ,, °
Parcel Number Legal Descnpbo Is the pro •in question
eat Property ❑Annually Assessed Motile Home(IC 6-1 1-7)
If any potion of the res:dential structure or the land not exceeding ore.,1 acre:-a: n,,.r.ea.ateiy surrounds that structure is used to produce income describe the use and portion I
of the property ut&ized to produce income
C -- Ili-5 -y00-00 _-1‘ - ot - OQl
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is Claimant Vacating a H stead'
I I ❑nes No
I
Sgrature o'`alma^t
I hereby certify the above statements are true.correct.and complete r, 0
4,2
Address of Contact(number and street.city state and ZiP cede) .dd�s of Ja'-ed Homestead if any(number and st�city.sf a an iF cocr
_ . . II• . '1,. — ,
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) Pit/
Total Land(line 1 plus line 2) (3)
bResidential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home I Garage (5) J N 08
Other Improvements (6)
o�4
I —
Total Improvements(Line 4 through Line 6) (7) ' 0/13 l
Total Value(Line 3 plus Line 7) (8) coUNTY �'�c iriSiv
Signature of Assessor !Date Signed(date month.year) ���1)-
I hereby certify the above is true,correct,and complete
Verdy.ng Action-Signature of Auditor Care Signed(date month.year
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$46 000
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 o/to a manufactured home that:s not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home
Signature of Auditor _
- ^
udi Date Sg fled--(month day
OISTRIBUTI N: Original-County Auditor File-Stamped Copy-Taxpayer
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