Homestead_Watts heist iiiiri
-1' -...% CLAIM FOR HOMESTEAD PROPERTY TAX
4 :..`Zi STANDARD/SUPPLEMENTAL DEDUCTION FORM YEAR,
HCIO
,.+-.�s State Form 5473(R20/12-24)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for tiling instructions.
NOTE:Telephone,Social Security,driver's license,state identification end federal identification numbers are confidential under IC 6.1.1-12-37.
CERTIFICATION STATEMENT
I(We) 0i 1`" , 77-6 certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the lollwjn�,a5�ri�G�),rgalAtzarty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, (�Jf66QQ�� L�ff rr f�fjj `` (date of signature).I(We):
0 Am(are)buying under recorded contract.
tAntyvn(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.
0 Am(are)the shareholder,partner,or member of the entity that owns the property.
r If Buying on Contract,Fee Simple Owner's Name /
Recorder's Office Where Contract Is Recorded J Record Number Page
PROPERTY DESCRIPTION /�
.....,
Parcel Number Legal Description iJ U IsCthe p-•:- In q - lion: a, !F (/_J`(L)
!IA Real Property 0 Annually Assessed Mobile Home(IC 6-1.1.7)
It 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. �y
e2pr— fq--r 3 -4 D —DO.2 . 466) — 0 2C-
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
0 Yes No
t"3ignei( 1I hereby certify the above statements are true,correct,and complete.Address Contact number and street,c te , . IP... re! asht
Vacated Homestead,if any(number and street,city,state,and ZIP_ /� code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE 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)
Annually Assessed Mobile/ '
Manufactured Home Garage (5) JULJ 2�� '�
Other Improvements (6) )
Total Improvements(Line 4 through Line 6) (7) / f
Total Value(Line 3 plus Line 7) (8) G/$$ oQ. ,1
Signature of Assessor • UUtnigned(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 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 manufactured home that is notassessed as real property may not
exceed one-half(1/2)of the asse od value of mobile homea or m factured home.
Signet e f Au it7r- _ A , � Date Si�ne¢Tmo h,day,yea ,1+�/�
/3?
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpay r
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