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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
State Form 5473 (R1216 -09) s
Prescribed by the Department of Loml Government Finance
INSTRUCTIONS., See reverse side for firing instrvchtons. ck-
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CERTIFICATION STATEMENT
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(we)
certify the (wet a4�rtny (our) principal
place of residen or am (are) buying a ollowing described real property for which a Homestead ProperIPISSO MQ gcty�VPibi* by claimed
under tract a date this application is filed, (date of filing):
(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
CONTRACT ••• r
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
n Township Taring district (dry, town, township)
Mn r //��(� Legal description - the props question:
• W o •�� Moo al property ❑ Annually assessed mobile tome (IC 6- 1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) ace that immediately surrounds that structure is used to produce Income, describe the use and portion
of the property utilized to produce income.
.
PROPERTY OWNED BY CLAIMANT
IN OTHER COUNTIES
County Township
County
Township
I hereby certify the above statements are We, correct and complete.
S re �mant
dre (n umber and sheet. city, fe,and code)
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ASSESSOR • ASSESSED
AT 100% OF TTV
• r NON-RESIDENTIAL
VALUE VAL UE
Land not exceeding 1 (one) acre Immediately 1
()
y?rZUiT` -n¢'.% "- ?^g
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surrounding residential improvements.
s :— -a`�a" G »4fa�.= -.t
Other land
(2)'r���`"�'`
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
i ts . k +� u +::<
Residential Improvements or Annually
Game
(5)
-> krt A� M0"'�, "rte'
Assessed Mobile 1 Manufactured Home
Other Improvements
(6)
x yFig
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (aanth, day, year)
STANDARD
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any ofherprovision, the sum of the deductions provided in IC 6-1.1 -12 to a mobile home that is
$
not assessed as real pmpeny or to a manufactured hone, that is net assessed as real property my not exceed
_
onehaff (12) of the assessed value of the mobile home ornmuladured home.
Signature of Auditor
Data signed (month, day, year)
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