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Homestead_Schenks (2) Reset'•Fomi w ° CLAIM FOR HOMESTEAD PROPERTY TAX YEAR qil°'4 ! STANDARD/SUPPLEMENTAL DEDUCTION FORM •• State Form 5473(R20/12-24) a4.--' - 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. � �A�lmiy CERTIFICATION STATEMENT . i�— I(We) EL �L�_�./!1' [Ft Z2 — c lur'�� e)occupied as my(our)principal place of residence or am(are)buying the Ito/in p(s -•, eat o. 1'Under co ct for which a Homestead Properly Tax Standard Deduction is hereby claimed on the date his application Is signed, t b (date of signature).I(We): Own. 0 Am(are)buying under recorded contract. 0 Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 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. If Buying on Contract,Fee Simple Owner's Name Recorder's Office Where Contract is Recorded Record Number Page PROPERTY DESCRIPTION Co Q /{ To� . j Taxing District(city,toowwjn,,township) 11 (9/fl I-I-1 4 111 &17-6/ Parcel Number L- uescription Is the property In question: Real Property ❑Annually Assessed Mobile Home(IC 6-1.1-7) 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. . 026 - i 4- /8 --. / `3 -‘900 , 7 1 5-6 --DO 7 ........ PROPERTY OWNED ELSEWHERE BY CLAIMANT ' S ,le, n and Tp ^sh ,n• 1 _ G1//�� Jp Is Claimant Vacating a Homestead? r�•�• �r { V! !/ /,':.J�7J - AYes ❑No eCe Signature of Claimant n n / f I hereby certify the above statements are true,correct,and complete.�e. `C � �C"� -, LU�Ie��'1 n!/n. Addre o o tact fin b, :,d street,city,state,a •,IP cod: �/+-1 / © Address of Vacatedc Homestead, y(number an treat,a fete, i.ZIP rp.e)��// ] Cou 'a T ilriL • SC, ./%a -! E tA-. 'I 7Z(1/ ,t n ASSESSOR USE ONLY j ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE -7 �(/ Land Not Exceeding One(1)Acre Immediately (1) i i Surrounding Residential Improvement Other Land (2) ('ti Total Land(line 1 plus line 2) (3) TT 0 . Residential Improvements or Dwelling ' (4) •IL Annually Assessed Mobile I �■T/■ • ^ Manufactured Home Garage (5) 1 Other Improvements (6) JUL 2 4 7 / Total Improvements(Line 4 through Line 6) (7) �r+LJ re.) Total Value(Line 3 plus Line 7) (8) .2�-""'{Gn Signature of Assessor t ate m nth,ye r 0 I hereby certify the above Is true,correct,and complete. G1SS0N CO ►i Verifying Action-Signature of Auditor Date Signed d fer ,(l Lin STANDARD DEDUCTION ALLOWANCE 20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000. 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 property or to a manufact' d home that is not assessed as real property may not ' • exceed one-half(1/2)of the asse sad value of a mohe home ormenuracfured home. Signet a ASditor ' Dar Si ed N/ytari)g.s.... DISTRIBUTION: Original-County Auditor,Fite-Stamped Copy-Taxplye Page 1 of 3 ResetForn; . -