Homestead_Koberstein (10) ��,..^•n„ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
{x - STANDARD/SUPPLEMENTAL DEDUCTION FORM 2� t1
(jyo State Form 5473(RiS/1-20) NCI()
"—„Th'-v. 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.
"I CERTIFICATION STATEMENT
I(We) It Ifko' - certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real prop�rrt�tY,e co r ct for which a Homestead Property Tax Standard
)(Own
is hereby claimed on the date this application is signed,10 / .��� (date of signature). I(We):
115 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.
)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County '\ Township Taxing dis irxt(city town,township)
inn. 1 �o
Parcel number Legal description Is t e p petty in question:
Real property ❑ Annually assessed mobile home(IC&t.t-7)
i
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds th t structure is used to produce income,describe the use and portion
of the property utilized to produce income.
3 — \ OO . 30_02s
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township is claimant v at a homestead?
[] Yes No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. ' �l g—mot .
Address of col(number and str et,city,state,and ZIP code) Address of vacated homestead,if any(number and street,city,state,and ZIP code)
)60; I• :Alm_ f .n-.�Y,-�� "I-0,
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately 7 �"u surrounding residential improvements (1) z' ,"t h :
Other land (2) 'c �W ' a f,j''{.
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) a . .,_.Ac`ttl �awx=
annually assessed mobile I
manufactured home Garage (5) I + f:;, '4 ` a1' c+.
�... 3 `'ws.
Other improvements (6) x KrsS.; n. , ?ga , ._ h,
Total improvements(line 4 through line 6) (7) Q/ti�
"� 1 r x
. C j
Total value (line 3 plus line 7) (S) ^- ! -,•
"Y e;
I hereby certify the above is true,correct, Signature of Assessor 6'sO lO� Date signed(month,day.year)
and complete. 4, i
Verifying action-Signature of Auditor �A� ` Date signed(month,day,year)
��.YYY y rcGb�"'
STANDARD DEDUCTION ALLOWANCE _
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. 0,?
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 manufact .-d home that is not assessed as real property may
not exceed one-half(1/2)�of the assessed value•' jie home or manufactured home.
Signatu 'or C — -.\� Date ys1igned( ogfty,dayygar) {V,i1
DISTRIBUTION: Original-County Auditor,File-Stamped Cop - axpayer
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