Homestead_Wirth i 4,. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
ii i
t� STANDARD/SUPPLEMENTAL DEDUCTION CRD �2�
ItsState Form 5473(R18/1-20)
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
1 I(We) ./ VI PS V 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
Y 9 9 P P Y P Y
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
AOwn. CI Am(are)buying under recorded contract.
❑ m (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
1 ❑ 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.
I`If buying on contract.Fee Simple owner's name
j Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County ') Township Taxing district(city town.township)
G •son OZ3 - Q.�,L�; A • _ _
~ -
Parcel number Legal descnptien I the operty in question
Real property ❑ Annually assessed mobile home(IC 6-f 1-7)
I.
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds tha structure is used to produce income.describe the use and portion -
of the property utilized to produce income
2-C.- \l'--\ S '--- r -C) --' C90 \ . 23 -1 . ..-- OZ.S ,.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County.and Township Is claimant V.P g a homestead?
❑ Yes /41 No
I Signature of claimant i
I hereby certify the above statements are true,correct,and complete.
dA dress of contact(number and street.city state and ZIP code) :•dress of vacated homestead.d any(number and street.city state.and ZIP c_.'_
y IL\ �;Ohio-Sk- Q)1 No'el-x1— \94
ASSESSOR USE ONLY I ASSESSED VALUEI '.OMESTEAD VALUE NON RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately 1 s .x 5"�I
_surrounding residential improvements ( ) ._--_ _ _ - _ _ -_ ?h ?;'
Other land (2) yp
Total land(line 1 plus line 2) (3) J4,
! Residential improvements or Dwelling (40/ 1 f I-WI�� 4.
I annually assessed mobile 1 — o4,
— t» -
imanufactured home Garage (5)
S f ;--. 1
Other improvements (6) e/ F f 't ~`c
f— - /
I Total Improvements(line 4 through line 6) (7) .94: —
I Total value(line 3 plus line 7) (8) �?"
hereby certify the above is true,correct, Signature of Assessor •T r ate signed(month day year)
I and complete.
I 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 545,000.
I
! 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 value of the home or manufactured home.
Signature of Auditor 1Date nail(mo h.day year)
DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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