Homestead_Gaston (12) .p •� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
edit t� STANDARD/SUPPLEMENTAL DEDUCTION FORM
°� State Form 5473(R18/1-20) HC10 �Z-I
ti ,i,� 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)Vl • my) °�y r1 certify that I(we)occupied as my(our)principal
place of residenOwAr a re)buying theT following described real pr9p /u der contact for which a Homestead Property Tax Standard
XOwn.
Deduction is hereby claimed on the date this application is signed, �b 2-9 (date of signature). I(We):
❑ 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 owners name
i
I
1
iRecorder's office where contract is recorded I Record number Page _-_,
PROPERTY DESCRIPTION
County Township Taxin ri (city town,township)
�\so() 02�'-- —- 14ovi . - -
Parcel number Legal description Is t�erty in question ----
eal property 0 Annually assessed mobile home(IC 8-1 1-7)
I II any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds lb structure is used to produce income,describe the use and pomon
or the property utilized to produce income
2--C-12- 07-- wl-\ - DoO . a12 ^ C ...- 1
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County.and Township Is claimant vac:' •a homestead?
❑ -s /. No
i
---
I Signature of claimant (
I hereby certify the above statements are true,correct,and complete rAlp
. (L.L _ Aral/..- 0i
tress of contact(number and street,city statej n ZIP code) Address of v. -d homes ' f any(number and street-city.state.and ZIP code(
72( b S t.,, - ssr V�'P)-Di-)-1-\7 0.0 III
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately I
l1) .,tr r•-� yr;-t.
-:
surrounding residential improvements _ _ T.. ,,..�
Other land (2) Jr'• rk ` F'll its•
Total land(line 1 plus line 2)
Residential improvements or Dwellinglift r£ 11•_ t--
annually assessed mobile I 1 —
manufactured home Garage )
Other improvements (6) P t ..
-_ Y,.1, '(
Total Improvements(line 4 through line 6) (7) Q\ —_
r
Total value (line 1 plus line 7) (8) I ''S1111
I hereby certify the above is true,correct, Si.e r -•`".r s• (Date signed(month day.year)
and complete. 0
Verifying action-Signature of Auditor Dale signed(month.day.year)
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
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 oft ' home or manufactured home.
Signature of Auditor ` Date i ned(mo th.day.year) 1
'mil — 2k _
DISTRIBUTION: Original-County Auditor.File-Stamped Cop er
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