Homestead_Clark (10) :i., Reset•Fonn
" CLAIM FOR HOMESTEAD PROPERTY TAX
y:4 - :�=� YEAR
•r 1iA STANDARD/SUPPLEMENTAL DEDUCTION FORM
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d;., ° f State Form 6473(R20/12-24) HC70
•'_ 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 r VI��'r certify ( )occupiedmy(our)principal place of
• that I we as
residence or am(are)buying the foil s t r e 1y vnder'tonuad for which a Homestead Property Tax Standard Deduction is hereby claimed on the
❑Own. ❑Am(re)buying is application is signed, �) (date of signature).I(We):
Ow under recorded contract.
(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
Recorder's Office Where Contract Is Recorded Record Number Page
PROPERTY DESCRIPTION
County \ _
() Township O Taxing District(city,town,township)
, -Parcel NumbJ� / Legal Description //1(/-••\J v a roperty In question:
Real Property ❑Annual/Assessed Montle Home(IC 6-1.1.7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately s oun that structure Is used to produce Income,describe the use and portion
of the property utilized to produce income.
26 — \I— 1 S --1-1 ) 0 0 3 --11 )r - ---o •
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is i nt Vacating a Homestead?
Yes ❑No
Signature CI Imam
I hereby certify the above statements are true,correct,and complete.
Address of Contact(number and street,city,state nd ZIP code) ress of Vacated Homestead,if any(n ber end street,city,stale,and ZIP cod?)
EZ� S SO-1 W. '\ .fir)—k• tG r- G li3 q— — O \'c :9n_ t�1�-6�r
ASSESSOR USE O)J'_Y I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
.ASIVAnnually Assessed Mobile!
Manufactured Home Garage (5)
Other Improvements (6) ��
Total Improvements(Line 4 through Line 6) (7) 0r! •
V ��rO p�
Total Value(Line 3 plus Line 7) (6) Ike
` (�
Signature of Assessor a`1Y . Date Signed(date,month,year)
I hereby certify the above Is true,correct,and complete. V
Verifying Action—Signature of Auditor n•SO`GO Date Signed(date,month,year)
\V
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$46,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $
is not assessed as real properly or to a manufactured home that Is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile ho o anufactured home.
Signature of Auditor __w_ f�c r Date SIn th,da,year)
YV 1liv�/1....\.�I„_vs.
^L� .
DISTRIBUTION: Original—County Auditor,File-Stamped Copy—T
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