Homestead_Pattersona���� ; CLAIM FOR HOMESTEAD PROPERTY TAX
': CREDIT/STANDARD DEDUCTION
.E � .
_.
.�:,;� State Form 5473 (R2 / 5-92) '
�eu
INSTRUCTIONS: See ieverse side 7or (iling instroctions.
fORM AR
HC10
- ERTIF ATION STATEMENT � � - � -
„i . �
I(We) __ certify that on ihe tst day of March. 19 -�
�occupied as o rincipal place of r ence Ihe following described real property for which a Homestead Propeny Tax Credit is hereby Gaimed: �
i I(We) owned ❑ Are buying under contract .
,Have a beneticial interest in the entity that is liable for the pmperty ta�ces on the pmperty and ihat owns the property or�c�11{jp�der� ntr�a�ct.
' �.1 � ��
I I
- . . .CONTRACTRECORDED � '
It buying on contract. Fee Simple owner's name _ - - , - FEB 1 9 �f�(�3
Recorder's oflice where contract is recorded Record pGrtiber r. Paqe
Counry
P ce u ber
If any pomon of Ne re�
oi ihe pmpeM Ufiiized to
' PROPERTY DESCRIPTION
Township Taxing district (
Legal description
ihe land not exceeding one (71 a e t at immetli ,ety surround:
' -J '
3 - -/D 3 . 2�'� _
�hat 5trucNre is used to produce income, descnbe the use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Couniy Township County Township
� hereby certity the above statemenis are true, correct and complete. Sig e of claimani
'ress (numbei and slreel. ciry, s . ZIP code) �
ASSESSOR USE ONLY . TRUE TAl( .. ASSESSED HOMESTEAD NON-RESIDENTIAL
.VAWE VALUE VALUE � VALUE
Land not exceeding 1(one) acre immediateiy
surroundinq residential improvements. (�) �'
Otherland (p) �
ITotal land Qine 1 plus line Z� (3)
Dwelling (4) - �
Residential improvements ..
Garage (5)
Oiher improvemenis � (6)
Tmal improvements (line 4 through line � (7) � "
Total value (line 3 p6s line 7� �g)
I hereby Certify the above i5 irue, CorreCt, and Sgnature ot Assessor Date signed
complete.
Verifying action � Signature of Auditor Date signed
STANDARD
19_Pay79_
Lesser of 7/2 Homestead
Valuation or $2,000
��
S
>9 y�
"'" CLAIM FOR HOMESTEAD PROPERTY TAX
S ._ STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R12 / 6-09)
' � PrescnbeE by Ne DepartrtreM a( Local GovemmeN France
INSTRUCTIONS: See re�erse side /or filing instructions.
� � (We> • certii„ that � (vre)
pWce of residence am (are) buyin Ihe folbwing described real property for which a Homestead Property Taz St��$�(
under contraa on ihe date lhis application is filed, (date of filing):
❑ �(we) own ❑<vn (are) buying under recorded convact
❑ Am (are) enlitled to occupy as a tenanFStockholEer of a cooperaGve housing corporation
� Have a benefidai interest in the ws[ or the right to occupy the property under the terms ot a quali�ed personai residence
��/
�
�
"�."
rc a^Y Portlo^ N Ne retidential sWCW�e u the Ia�M rot emeeA'm9 are (1) aoe tha
� o, ma wo�m w�a m�a� �,m�.
o?� - ia _ 33 _ 5��, ao% .sdi-oa 7
�
Ca�my
Tovmship
I hereby certiy ihe above stetements are we, corted and complete.
Address(numberandstree;cily,slEte.anOZlPCOtle) � . .
Land not exceeding 1(o�re) acre Immetliatey
Otherland
Total land (line 1 plus line 2)
Raidenllal improvemenb or Mnually �Iling
Pss�setl Mobile / ManuFactured Home Garage
Other ImProvemertts
Tohl improvements (line 1 Nroug� Iine �
Total value (!!ne 3 pf�s Ilne 7)
I hereby certify the above is we, cortect,
and wmplete.
Veilyug actian - 55ren�re of �tnr
(�)
(2)
(3)
(4)
(5)
(6)
Caunry
�� I'�9
Recad number
I�s irnhey roperty in Question:
yU Reel poperty ❑ Mnua%assE
N�IES ih'dI6bUCfI1R 61152C t0 PIOCW0111ftlf1E,
� � yz��d
20 _ pay 20 Lesser ot 60% of Ne assessed v�ue of Ne homestead or $45,000
NoMilhslaMbg any oNerprovision; Ne sum oI Ne tledulrorts pro�+ded in IC &7.1-12 to a rtrobile hortre Nef A5 $
nof assessed ac ieal property w ro a manufactured frome fhet 'a not %ssessed es real properry mey nof exceed
onehatl (1R1 d Ne arseacatl ve/ueW the mobde home or rrenuJaWred hor+�c.
Signat�ue of Putlitw
TovmsNp
y
1�
YEAR
�r °
i � t:
E✓ 1L..�e`
2013
Pege
ile fqme (IC 61.7-
1�18 1150 dfld PORIOII
Date signed (manfh, day, yaa�
Date
Y��
5�'