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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
6 State Form 5473 (R1216-09)
' Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
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CERTIFICATION STATEMENT
I (We) certify that I (we) occupied as my (our) principal
place of residence or am (are) buying the toll ing described real prop rty for which a Homestead FiToperty Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
I (We) own ❑ Am (are) buying under recorded contract
Am (are) enUUed 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 of claimant (bgel nor )
Social
Social Security
if buying on conbaa, Fee Simple owners name
Recorders office where contract is recorded Record number
Pape
PROPERTY
Count'
Township Tabrg d - , town, tawnsW )-
Parcel number
Legal description 1 Is the property in question:
ry
^ at j•�
I property ❑ Annually assessed motile tame (IC 6.1.1 -7)
If any portion of the residential swcture or the land not exceeding one (1) acre lh imfmadiatay surtountls t swcJUre is used to produce income, describe the use and portion
f the property ulilaed to produce income. , / C
I C 30
/ ,4 c
PROPERTY BY CLAIMANT IN OTHER COUNTIES
County Township Count' Township
I hereby certify the above statements are true, comect and complete.
Signature of aim t
Address (numberand street, arty, state, and ZIPcode)
7 9 5• 1250 E. C_ r/ v4 �loa
ASSESSOR I ASSES ED VALUE (sly
USE ONLY TRUE TAX VALUE
Yffl%
AT 100%/. OF TTV
Lanrrd not exceeding 1 (one) acre immediately
suoundin residential improvements. (1) x^
Other land
(2)
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
it'�.J` -` �„rrfi.�•st`,.
- •'?+� �` 4 �r ,nx.e>�v�.
Residential improvements or Annually
Garage
(5)
Assessed Mobile 1 Manufactured Home
Other Improvements
(6)
Y i
Total Improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Data signed (month, day, year)
STANDARD DEDUCTION
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwitistandirg any otherprovision, the sum of the deductions provided in IC 6-1.1 -12 to a mobile home Net is
$
not assessed as real pmpery or to a manufactured home that is rot assessed as real property may rat exceed
o e- heH(12) rime assessed value of the mobdo tame or manufactured home.
Signature of '•a
Date signed (monm, day, year)