Homestead_Bittner CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
i:- , STANDARD/SUPPLEMENTAL DEDUCTION FORM
6 State Form 5473(R18/1-20) HC10'tea_ y� Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS See reverse side for fihng 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) Q U\ OV 4- Dan . I ° certify that I(we)occupied as my(our)principal
place of residence]or am(are)buying the following described real proper under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, j f J 7�Q�N (date of signature). I(We):
Li 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
Comy Township Ta d,stnct(city,town,township)
(7IbS0r\ U r i OY) POY--\- 'bikCavOkiN —lb wry
Parcel number Legal description ' '�'Is the property in question:
1(„-I q -i q,l1� o 1 -SoLAWAG 2/ LY Real property LI Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structurtrolTfIT5 land not exceeding ne(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township /'� /' Is claimant vacating a homestead?
- VYLtrepzvriiisfrQV ,/ inisLyl/'Si ❑ Yes �No
/ Sri n//aturr a. I
hereby t above statements are true.correc, -n•complete. -
Address of contact(number and street.city state,and ZIP code) Address o ed homestead,if any(number and street,city,state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile I
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date 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$45,000. (�"S 5
Notwithstanding any other provision.the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ (d
that is not assessed as real property or to a manufactured home that is not assessed as real property may �S^—*��
not exceed one-half(1/2)of the assessed value o -_r obile home or manufactured home. `�
Signature of Auditor Date jined( onth,day yeah ���� J �
Or1W,,,,,0
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer ic \i 1\
Page 1 of 2 �` �
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