Homestead_Mellor ,v- CLAIM FOR HOMESTEAD PROPERTY TAX =Mil
t I STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R19/1-23) HC10 HMI
^s 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/C 6-1.1-12-37.
/1� ,I 1� CERTIFICATION STATEMENT
i(We) DE.i$pK/r I-I rq E,1.LC)e4» certify that t(we)occupied as my(our)principal place of
residence or am(are)buying the following dggscribe real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
dat�plication Is signed, I i/4p/2OL2,'.((dale of signature).I(We):
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 fX
County Township Taxin District(city,town,towns v- x ,_
Parcelg bsa7r... kizi
2} Number /� +�/�/'� ,�,Lreeggal Description Is the grope question: Cs..1 'd
c `i 1 r�I—r14(.)t) °r cv• 11 rJ -£2' I eat Property 0 Annually Aqe.Fixsed Mobile Home(IC 64.1.7) >
ir If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion O Z
of the property utilized to produce income. M>
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CD 0
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17 I� O
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PROPERTY OWNED ELSEWHERE BY CLAIMANT, t, CO
(a
State,County,and Township ^�^; "' /^'� is Claimant Vacating a Homestead? i
Tn I A[ r r 7 r rj0 ' Yes ❑No '1
ru x/` Mire ofClai`` (nt �j� �).__, '/ l
I hereby certify the above statements are true,correct,and complete. / yr fy'I�"'� JC O� �(/
Address of Contact(number and street,ci. state,and ZIP code) Address of Vacated Homestead,if any(number an street,city,state,and lP de) 1
ASSESSOR USE ONLY ASSESSED VALUE ( HOMESTEAD VALUE NON-RESIDENTIAL VALUE �-^�
Land Not Exceeding One(1)Acre Immediately (1) } C= -` Q
Surrounding Residential Improvement
Other Land (2) U I f
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) � ( f
Annually Assessed Mobile/ vl\1
Manufactured Home Garage (5)
Other Improvements (6)
111....-
Total Improvements(Line 4 through Line 6) (7) ,
Total Value(Line 3 plus Line 7) (6) 0
Signature of Assessor Date Signed(date,month,year) (},_ri
I hereby certify the above is true,correct,and complete. Y'—
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Verifying Action-Signature of Auditor Date Signed(date•month,year)
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STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60P/e of the assessed value of the homestead or$48,000. ^ \
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Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $ S/
Is not assessed as real property or to a manufactured home that is not assessed as real property may not T
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
i re f Auditor Date Signedf'"onth,day,year)
Ve.:21964.0
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer/I
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