Homestead_Wilkison (16) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR •
4.114\_ STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R18/1-20)
Prescribed by the Department of Local Government Finance HC10 ME
...4La.
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,stale identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT '
I(We) / IVri mb r\.,, - MP( k. ._ Olf\, certify that I(we)occupied as my(our)principal
place of residence 1/4or (are)buying'the following described real pr y Un er corittact for which a Homestead Property Tax Standard
Deduction is hereby c aimed on the date this application is signed,
Own Am(are)buying under recorded. 1 2.- '2,, "-
0 contract.
Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. (date of signature). I(We):i
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
0 Am (are)the shareholder, partner, or member of the entity that owns the property.
CONTRACT RECORDED- -
If buying on contract,Fee Simple sinner's name
Recorder's office where contract is recorded Record number Page
- --
PROPERTY DESCRIPTION
County Township Taxing.strict ly.loam township)
township)
Vje\ CO V r
1 .Parcel num r Legal description l the °party in question, ,
Real property LI Annually assessed mobile home(IC 6-1/-7)
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
of the property utilized to produce income
--z a -cicz . 22_2 00 i
.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant v a' g a homestead?
0 Yes L No
—
I .
I .• /10 ..4
thereby certify the above statements are true,correct,and complete Signature.f claima•.
dress of contact(number.. and,sliett,,,city,state,ar:,;... ode) -----Tr.dress)4 acated homestead,if any(number and street,city,state,and ZIP code)
,
l‘' 0\. 1::,- IPOU-s 11' t. .-. - ' I
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)'acre immediately ,,,, ,•,0-5, ..0,,,,--
(1)
improvements
Other residential 'AMITs. -s. ,.'a,,V•i,:::''
Other land (2)
_-."•?..st,•,'S.ts•-•x47e:::3,(1',V•r.s4A-- -1
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) , tift,-..- ttlaisktti;
annually assessed mobile I
manufactured home Garage (5) ,•-:,.:."4-.::-J .,,.•. . , .: 3!
,
,.. F,zr...t..,?..,.,i,1-0
Other improvements (6) 1 •.t-:-:7,11,,,J-•M-S:•,.
Total improvements(line 4 through line 6)
11.0/ .. '
/47
Total value (line 3 plus line 7)
Signature of Ass% 4:2 Date signed(month,day.year)
I hereby certify the above is true,correct,
and complete. (,t4f•,,..... "
Verifying action.Signature of Auditor 1)** Date signed(month,day.year)
`16Nzii.,
.....7),..
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 601's 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 o a-half(1/2)of the assessed value of the mobil manufactured home,
Signature of di
\
Date ' d(iroT....ci yola
DISTRIBUTION:Original•County Auditor,File-Stamped Copy.Tax ,
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