HomeMy WebLinkAboutHomestead_Ashby (3) init a CLAIM FOR HOMESTEAD PROPERTY TAX FORM ,
STANDARD/ SUPPLEMENTAL DEDUCTION �1/\
..q t' State Form 5473(R13/12-09) HC10
Prescribed by the Department of Local Government Finance l
INSTRUCTIONS:See reverse side for filing instructions.
Miss 1t°.°e`-:sv+if'':- "3 ?c ;.9.tC:tri':Airtrifera RTIFICATION;STATEME14WiSiE1'SA! g T 'rtPS ;t i--?st,j Z1 :rr e .-`.Y.
I(We) 7711.741 EMitg2 certify that I(we)occupied as my(our)principal
place of residence or am(are)b ying the following d:siribed real property for which a Homestead Property Taxkli tYda4}7it4194,2on is hereby claimed
-der contract on the date this application is filed, (date of filing). I(We):
C.J.n
Own ❑ Arrt(are)buying undei 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 qualifiIrgdXcOttlidsITOR ,
❑ Am(are)the shareholder, partner or member of the entity that owns the property.
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
O??: M ir. * Vs:gs.< RgiM.�L � PROERTDESCRIPION �Yiat� .. a;ri6.ss . a : . F 1 _
Township Taxing district(.• ,I. ip)
P noel nuI1(tu(ber r�1-CO Legal deessaaiption Is property in question:
(-1 1— I a-aW COQ(.b / � I property ❑ Annually assessed mobile home(IC 61.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surroun that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
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xa,jai;.4;;. r<.' �� � 1 K.:-.r`*, PROPERTY`OWNEIRVI LAIMP.M1T:-'-INO11:1 COUNTIES-1%12.113 l*:?A'-kAgri`,�,`:. #::--;�`.�<;S
County s Township County Township
I hereby certify the above statements are true,correct and complete. nature of claimant
'1CC�)11c1 (a4t 4r
Address(number and street sty,state,and ZIP code) - /(
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u
'£.s‘./ x-s S e '-'4 '` +a i r E f�.,.'e :2 1 irASSESSED VALUE'WI16MESTEAD t
'
: NONRSDENTIALiy
x ,- +{ 7ASSOR USE:ON ! t.- tai rTUEFTAx VALU. I'*AT F1g0 u OF TT ,f ��:S VALUE>> Y11-1_rfr'x isVALUE rc* ^>.
1';
Land not exceeding 1 (one)acre Immediately s•v,trs i- ` r T'
surrounding residential Improvements- -
. i_"VV,'
e;
Other land (2) �sea �-
i
Total land(line 1 plus line 2) (3)
Dwelling (4) ✓ %a'ig 1Lt man-nkrsi
Residential improvements or Annually
Assessed Mobile I Manufactured Home _-; ,,i +- -J s'f_ ,
(5) : =
n^s211v -e :y.
Other Improvements (6) ,f-,-
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Data signed(month,day,year)
and complete.
Verifying action-Signature of Auditor - Date signed(month,day,yea)
rz'^e _,:n . .€;'Y€.:,,..k12 cr-..s.4St§3s,%STANDARD_ EDUCTION;ALLOWANCElix -:`*.T:.:;<.s..r fli.fieng .-, .3t 71 ,u<.._
20 . pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real properly may not exceed
we-MO/Rol�1�f /rf//��1,va'lue of the mobile home or manufactured home. rs5 tr/