HomeMy WebLinkAboutHomestead_Vowells Reset Form'
.. `" i. CLAIM FOR HOMESTEAD PROPERTY TAX P YEAR
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; STANDARD / SUPPLEMENTAL DEDUCTIONFORM.� ' State Form 5473(R20 l 12.24)
HC10 C C.Prescnbed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions
NOTE Telephone. Social Security drivers license, state identification and federal identification numbers are confidential under IC 6-1 1-12-37
CERTIFICATION STATEMENT
I (We: I eA D A - ' $ , I certify that I (we)occupied as my(our)principal place of
residence or am (are)buying the fQ x • nbed reroperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
d tries application is signed `� 'ti► 2 (date of signature) I (We)
Ood
wn l
. 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
CONTRACT RECORDED
If Buying on Contract Fee Simple Owner's Name
,
Recorders Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Townsh Taxing District(city, town, townOc ?
_.
Parcel Numbe Lega,DesM6in I th roperty in question
Real Property ❑ Annually Assessed Mobile Home(1C 6-1 1-7)
If any portion of the residential structure or the land not exceeding one (1)acre that immediately surr rid that structure is used to produce income,describe the use and portion
of the property utilized to produce income
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County, and Township Is Claimant Vacat g a omestead,
Yes No
Signature of Claimant
I hereby certify the above statements are true, correct. and complete.
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Address of Contact (number and street city state rid ZIP code) Address of Vacated Homestead, if any(number and street. city stale. 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)
Residential Improvements or Fr-VI:El:4)
1 Annually Assessed Mobile I 'i Manufactured Home e 15)
Other Improvements (6)
Total Improvements (Line 4 through Line 6) Wil
Total Value(Line 3 plus Line 7) (8)
Si atiiik*s - - - Date Signed(date,month.year)
I hereby certify the above is true. correc a d coin lete. t y�� En-TOR
Verifying Action-Signature of Auditor *t CC, Date^Date Signed(date month.year)
G\BSO 1
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or S48 000
Notwithstanding any other provision. the sum of the deductions provided in IC 6-1 f-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 i e or manufactured home I
Signature Auditor Date Sig a( d y To
1L ^ 3,-----
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DISTRIBUTION: Original-County Auditor File-Stamped .vp=7-Taxpayer
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