Homestead_Parrish /-":,; CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
g[�. !� STANDARD/SUPPLEMENTAL DEDUCTION FORM
ttx- C Stale Form 5473(R18/1-20)
HC1D •
' �� 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(We) (1l\ S� certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
i
"Own. El Am(are)buying under recorded contract.
m (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.
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
j Recorder's office where contract is recorded Record number Page
I
PROPERTY DESCRIPTION
County /`\ Township Taxing district(city town,township)
Parcel numb I il
�O� Legal description IsIs he pr porty in question
Real property ❑ Annually assessed mobile home(IC 6-1 1-7)
/It any portion of the residential structure or the land not exceeding one(1)acre that immedhately surro ds at structure is used to produce income.describe tire use and portion —
of the property utilized to produce income
— II -1Z - 3- d0Z 143 -028 .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
i
State County.and Township Is claimant va ' g a homestead?
❑ Yes No
--- _ — a ure f claimant
I hereby certify the above statements are true,correct,and complete. i
r
Address of contact(number and street.city state and ZIP code) 'Address of vacated homestead.if any(number and street,city state.and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately fiW '"�iir
surrounding residential improvements (1) ?. mr.,,-''
Other land (2) 1irE ."'+CSittifr•',
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling 'j,? f 1
annually assessed mobile I
manufactured home Garage
n
Other improvements ( *� \ii ' .44,j ti it
Total improvements(line 4 through line 6) (7) , J�
Total value (line 3 plus line 7) (8) Vick I"-
,_
I hereby certify the above Is true,correct Signature se aGOJ Date signed(month day year)
and complete. .1 et
1 Verifying action-Signature of Auditor C, Date signed(month.day.year)
1
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
1 that is not assessed as real property or to a manufa d home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value o h
e home or manufactured home.
Signature of Auditor \cvsDate onth.d .Sr....) r'_/l.....tA`I
upcXx
DISTRIBUTION: Original•County Auditor,Au File-Stamped xpayer , 1
s J � _ , Page 1 of 2 n r i tie 71 t1
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