Homestead_Watt (7)❑
"'" CLAIM FOR HOMESTEAD PROPERTY TAX
__ STANDARD / SUPPLEMENTAL DEDUCTION
S � State Fortn 5473 (R72I6-09)
�O � Prescnbed by Ihe DepaMcent af Loml Govemmefrt Firrence
INSTRUCTiONS: See reverse side !or filirg insUVCtions.
� � YEAR
JL
HC1
1
C.1_m..-�..
I(VJe) certiTy that I(we) ocwpied as my (our) prindpal
place o( residence or am (are) g the fo lowing desaibed real property (or which a Homestead Pmperty Tax Standard DeCuction is hereby daimed
under contraG on the date this application is filed, (date of filing): .
❑ I(We) own ❑ Am (are) buying under recarded contraa '
❑ Am (are) entl0ed to ocwpy.as a tenant-stockholder ot a cooperaGve housing corpora8on .
� Have a benefidal interest in Ihe wst or the right to occupy the property under the terms of a qualified personal residence Wst
Name of auiant (legal name) , 'f
CJ•^ l.�
nartre)
Sodal Securiry number ot tlaimanYS spouu (lasf five Oigds) Drivers license I Itlentifiralion I ONe
- ot daimem's spouse (lasl (rve dqihJ
• •
11 Wymg m mnbact, Fee Simple ownGS riame .
ReooNeYS o(fice where rantracl is remrtled '
Counry
Tamship
(�Y �o�'R• townxhiP)
Issuing State
Rcard number � Page
ParrnJ numher pLe.g�al OesuiO� $�1% �Gs fi L. Is Ne properry in qu�tion:
I J /-� E iJ W J-:. � � ❑�� MaPertY ❑ AnnwAy assessed modle hwne (IC Gf.1-7)
�If any por�ion d Ue resi0ential strucW ra or Ihe IaM nol exceeding one (1) aae Ihat immediatety surtounds �hat strucwre is used in pmduce income, Eesaiba Ne use and portion
W ihe WoPenY uOTaed to P�ufa mcoma.
a�-ld,-o3-�00- naz.osy_oa7
�
�
Twmship
I hereby certify the above statements are We, cortect and complete.
PdAreu (number aM sfreet, dfy, state, arrd LP code)
Land not
Olher land
Total land (line 1 plus line �
Immediatety
ResidenUallmprovementsorMnualty ��ling
Assessed Mo6ik / ManuFac4ired Home Garege
Othrs improvemenb
Total improvemenb (llne / Niough lina �
Total value (llne 3 plls line �
I hereby certify the above is true, comect,
VefiyiMj acrim - 55rewre of NM'itw
(�)
�z)
(3)
(4)
(5)
(6)
Counry
ZD pay 20 _ Lesser of 60% of the assessed value of �he homestead or $45,000
NoMilASlarMUg any other proNsbn, Ihe sum o/ Ne tletlurlions provitled in IC 57./-12 ta a rtrobAe Irome Nat'u
mt esse.ssed as real poperty w to a manNaWied hartie Na( is nof essessed as real poperty maY �t exceed
nr�nhnM/f/11 N Me escr_acetl valua d Ne mobde home wmanWarlured frortie.
$
Twrtattip
(rtronfi. deY• Y��)
Date %igned (rtronth� OaY. Yea�
Date signed (monih, Eay, yxa�
rt.
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
State Form 5473 (RB / 403)
Prescribed by the Department of Lacal Govemment Finance
� INSTRUCTIONS: See reverse side Ioi filing instructions.
FOR.M.'- • � YEAR
HC10
1(We) � Ol � � _�1� certi{y ihal on the 1 st day of March, 20_
,I--(W,�e) occupied as our prindpal place oi res"�nce the followk�g desaibed real property for which a Homestead Property Ta< Credit is hereby daimed:
LYI (We) owned ❑ Ne buying under contract
� Have a benefidal interest in the entiry that is liable for the properry ta�ces on Ihe property and ihat owns the property or is buying under a contract.
I( byvg m oontrdp, Fee Simpie ownefs name
Recortlefs ofice where
Counry
Tavnship
Legal description
H eny porQon of Ne resitlentlal structure w the W W not euxtlinp �
01 the properry uLl¢eO tn produce income. � I/�
��ax� ��l
I hereby certify Ne above statements are We, corted and complete.
Mdreu (number a� sf�eef, ciry; atate, Z/Pcode)
Record number
Tacing
Pa9a
I Is Ihe property in question: ' /
❑ Real property t7/+1ob�e Homo (1.C. &/.1-n .
Net immediatety wrtounCS that sWCNre ia useA b produce income, desui6e the uee an0 portbn
-/U�- Qoo?. Do�� Do� �
�/� /, _
County
20_Pay20_
Lesser of 1/2 Homestead
vewauon or 535.000
b
o! Aud��a ' I Date sqnetl . ._