Homestead_Anderson0
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
s Y State Form 5473 (R12 16-09)
�O Prescribed try the Depanncem of Loral Govemmem Firana
INSTRUCTIONS: See reverse side for filing instructions.
I
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I (We)
certify that I (we) oceupiad as my (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ 1 (We) own ❑ 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
INFORMATION
Name f claimant (legal name)
good Serarity
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Name of claimant's spouse (leegal/name)
Social Security number of claimant's spouse (last five digits) Drivels license I Identification I Other number
IssuGg State
of daimant's spouse (last five dgb)
CONf RACT RECORDED
If buying on contract. Fee Simple ovmees name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County
Township
I
Taxing d' 'cl (city, town. township)
It
Parcel number
Legal description . I O•r� R C
Is the property in question:
'
p r W 5 CJ 3 5 - d � 9
E] Real property ❑ Annua %assessed rtrohle home (IC 6-1. 1-7)
If any portion of the residential struclum or the land not exceeding one (f) acre that Immediately surrounds that sbucWre Is used to produce income, describe the use and portion
of the property utJ¢ed to produce Income.
PROPERTY OWNED BY
County Township
Count
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, dry, state, and ZIP code)
I TRUE TAX VALUE ASSESSED VALUE
ASSESSOR USE ONLY AT 100% OF TTV
I HOMESTEAD NON-RESIDENTIA
I VALUE VALUE
Land not exceeding 1 (one) acre immedlataly
(1)
`-'I.- .y S§", 'b�`r"=
o �z" °^'+
surrounding residential ion rovements.
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Otherland
(2)"
Total land (line 1 plus line 2)
(3)
-
Dwelling
(4)
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Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
'S.
(5)
}.
Other improvements
(6).;a,
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Vuxiying action - Signature of Auditor
Data signed (month, day, year)
STANDARD DEDUCTION ALLOWANCE
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
NotwWtstandmg any other pmv sion, the sum of the deductions prowled in IC 6.1.1 -12 M a mobile home that a
$
not assessed as real property or to a manurecaired home Nat is not assessed as real property may not exceed
onehaff (1/2) of the assessed value of the mobile home or manufactured home.
Signature of Auditor
Date signed (month, day, year)
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