Homestead_Beasley (3)C
4
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
S Stale Form 5473 (R12/6-09)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for fi/ug instructions.
FORM YEAR
cfa `mss
1(We) - certify that I (we led as gt ur) principal
place of residence o am (are) buying the following described real property for which a Homestead Property Tax StandarB 059, �by claimed
under contract on the date this application is filed. (date of filing): GISSI ('� NTY AUDITOR
® I (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 terns of a qualified personal residence trust
INFORMATION
Name of of morn (legal name) ,
Sow'— ---
$
Q/
Name of claimant's spouse (legal name)
Social Security number of claimant's spouse (last five digits) Drivers license / Identification IOther number Issuing State
of claimants spouse (last rive digits)
CONTRACTRECORDED
It burying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Town ip
Ta)&V district (dry, town, township)
k
Parcel number
Legal description
Is the moperry in question:
2G-13_4L-!)0D -
® Real property ❑ Annually assessed mobile home (IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. /y� %
Il -a —r '
�Jw SvJ r_0
PROPERTY OWNED BY CLAIMANT
IN OTHER COUNTIES
Couny Township
County Township
I hereby certify the above statements are true, ccrec'. and complete.
Signature of claimant
Address (number and street, rrfy slate, entl LP / 1 (� 7 /��
6
r ✓` 1 7
r • r • r
ASSESSOR USE ONLY TRUE TAX VALUE
Land not exceeding 1 (one) acre immediately R',%y.>rr`.'"3
(1) ez:'
suroundin residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
- - -
i''p,r& •ah r4 h> - �
Dwelling
(a)
i) 1
1"�}.. y
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
-
(5)
Other improvement
(6)
E} Y',•,z -�*, ->'�
Total improvement (line d through line b)
(7)
Total value (line 3 plus line 7)
(8)
hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying action - SignaW a of Author
Date signed (monm, day, yea0
rr._.DEDUCTION ALLOWANCE
20 ' - pay 20 = - Lesser of 60% of the assessed value of the h^_mestead or $45,000.
Notwithstanding any other provision, the sum of the deduction provided in IC 61.1 -12 to a mobile home that is
S
not assessed as real property or to a manufactured home that is not assessed as real property may rat exceed
one-haff (12) of the assessed value of the mobee home or manufactured home.
Signature of Auditor
Data signed (month, day, year)