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Homestead_Thompson (20)
e, '<� ;,t CLAIM FOR HOMESTEAD PROPERTY TAX _+____ = 'j, STANDARD 1 SUPPLEMENTAL DEDUCTION FORM State Farm 5473{R19!1-23} MID �'j IM—_ 'i+8' 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) I Cc p '��$Oi7 certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, (date of signature).I(We): - Own. ❑Am(are)buying under recorded contract. El 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 N/) Recorder's Once Where Contract is Recorded Record Number Page PROPERTY DESCRIPTION County Township Taxing Dlstric cyy; own,town 1p) Parcel Number Legal Descriptio(�'C'�) th property In question: V Real Property ❑AnnuallyAssessed Mobile Home(IC S-1.1-7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately sun nds hat structure is used to produce income,describe the use and portion of the property utilized to produce income.-LT- 0 6s-1\ 2_,G ,_\ PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is Claimant Vacating a mestead? ❑yes No Signature of Claimant I hereby certify the above statements are true,correct,and complete. x,Ran ..-1 l„Y'N Q V.\ Address of Contact(number and street,city,state,and ZIP code) Address of Vacated Homestead,if any(number and street,city,state,and ZIP coda) f714 S,"4 it , 'i Pci44e2i''ff2 l/tV-7,47J- ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE Land Not Exceeding One(1)Acre immediately (1) Surrounding Residential improvement i e Other Land (2) s.n Total Land(line 1 plus line 2) (3) Residential Improvements or Dwelling (4) ./4 di Annually Assessed Mobile I rU # $' Manufactured Home Garage (5) 20 Other improvements (6) 0f� ` Total improvements(Line 4 through Line 6) (7) 41 CnchI2.z Total Value(Line 3 plus Line 7) (8) 71"q Signature of Assessor �Q/1 Date Signed(date,month,year) I hereby certify the above is true,correct,and complete. /� Verifying Action-Signature of Auditor Date Signed(date,month,year) STANDARD DEDUCTION ALLOWANCE 20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000. Notwithstanding any ofher provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $ is not assessed as real property or to a manufactured home that is not assessed as real property may not exceed one-half(11.2)of the assessed value of the mobile ho nufactured home. Signature of Auditor ins. � —I�/ c-- Date Signed('nanth,day, ar T V(L Jt J`�y 1 Vr) 1 2 DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 2