Homestead_SingletonCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R13112-09)
♦ yw Prescribed by the Department of Local Government Finance
INSTRUCTIONS. See reverse side for filing instructions.
FORM YFJ�R r
HC10
I (We) G• certify that I (we} pi s my (our) principal
place sidence or am (are) buying the fo wing described real property f which a Homestead Property Tax Standard Di r y claimed
d er contract on the date this application is filed, (date of filing). I (We): C • R
a Own COUNjY Pup1T0
Am (are) entitled to occupy as❑a tenem stockho der of a cooperative housing corporation ww)t4
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
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If buying on contract, Fee Simple owners name
Recorder's office where contract is recorded Record number
Page
••
County
Township Taring district (' town, township)
Farrel number
L description
Is the property in Question:
3 y—Z _
❑ Real property Annually assessed We tome (IC 6- 1.1 -7)
If any portion of the residential structure or the IarM not exceedi one 1) acre that Innitiediatefy surrounds that structure is used to produce income, describe the use and portion
of the property utilaed o produce Income.
® �, -� C •a 79
.. .:
County Township
I hereby certify the above statements are true, correct and complete.
Signature of da'smant
A
Acjrass (number and street city, state, and ZIP code)
i� LCOO k I— G
rr•,
Land not exceeding 1 (one) acre immediately d•--> - ,� }''r `'
(1)
surrounding residential ire rovements. '-
Otherland
(2)
-f•z
Total land (line 1 plus Ihre 2)
(3)
a- `,jiq-
ResideMalimprovements or Annually
Dwelling
(4)
X,r- •*,?>$.,=
Assessed MobBe I Manufactured Home
Caere e
Other Improvements
(6)
" Sr��✓�
Total improvements (line 4 through line 6)
(7)
Total value (line 3 Plus line 7)
(8)
1 hereby certify the above Is W e, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor Date signed (month, day, year)
r vi 111 itill:
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwilhstandimg any other provision, the sum of the deduc cris, provided in IC 6-1.1 -12 to a nubile tame that is $
not assessed as real property or to a manufactured home that is not assessed as neat property may rot exceed
one•haff 112) of the assessed vehre of the mobile home or manufactured home.
Signature of Auudiuv
Date signed (month, day, year)