HomeMy WebLinkAboutHomestead_Blaize (4) MQ VA',
at,:k. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
i• STANDARD / SUPPLEMENTAL DEDUCTION FORM f
State Form 5473(R19 i 1-23) HC10 r.L() .
'O•• 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) -3 r u -ce: - rYl_ / 1ai4 la I Le, certify that I (we)occupied as my(our)pnncipal place of
residence or am(are)buying the following de cribed property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, 1 D , ` �0 (date of signature). I (We).
SOwn. ❑Am (are)buying under recorded contract.
❑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 Owners Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Court-, Towns •axing District(city,town,township)
Cr1 bSon 'D C) , ter '1 IA cc ►mil
Parcel Number Leg escription !e Is the property in question:
A,(6 I $ 0 ? Z.6 3 00 oZ..g y 5 D ?-? La4 r!_c_Y`t ®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.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a H estead?
dgi❑Yes No
Sign lure of Claimant
I hereby certify the above statements are true, correct, and complete.t j //�
..)
Address of Contact(number and street. city, state, d ZIP code) -1/,�79 Address of Vacated H(ommeestead,if any(num and street,city, state. and ZIP code)
D r 0 - A Ve state,
ri . 'c-) c�
ASSESSOR USE ONLY ASSESSED VALUE I 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) FIL
Residential Improvements or Dwelling (4) Et*
Annually Assessed Mobile /
Manufactured Home Garage (5)
- � ocr
Other Improvements (6) O ?l%7 Total Improvements (Line 4 through Line 6) (7)
Total Value (Line 3 plus Line 7) (8) Giagla
Signature of Assessor —VW$Ruze� .!r}6IK, Year)
I hereby certify the above is true, correct, and complete. `'ZJ N ""!`
rYalv
Venfying Ac:ion-Signature of Auditor Date Signed (date, mon( n
PI
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 not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured horr-
Signature of Auditor • Date Signed(may,year)
-- .. ,1 , Th
DI. �_ TaxpayerfN(\\6._.0 .
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