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Homestead_Sokeland�..'" CLAIM FOR HOMESTEAD PROPERTY TAX ? STANDARD if SUPPLEMENTAL DEDUCTION 0 State Form 5473 (R12/6-09) Prescribed by the Department of Local Govemment Finance INSTRUCTIONS: See reverse side for filing instructions. FIFA Ell 41ill 21y •• I(we) Q cert;ry t�L�`i1' 'b��r�j1.(bii�QRndpal place of esidence or (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): ❑ 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 terms of a qualified personal residence trust CLAIMANT'S INFORMATION Name of claimant (legal name) i /„�v " – — _`Y • " Social Security Nam f daimant's spouse (legal name) - Social Security number of claimant's spouse (last five digits) Drivers license I Identification I Other number Iswing Sate N CONTRACT RECORDED If buying on contract, Fee Simple owners name Recorders office where contract is recorded Record number Page PROPERTY DESCRIPTION County Township Taring dm ? (city, wn, township) Parcel number Legal description Is the erty in question: ' Real property, ❑ Annually assessed nabile home (IC 6- 1.1 -7) ane, describe the e and portion I'- portion of the residential sm¢ture or the land not exceed'ug one (1) acre that Immediately w nds t hat structure 's used to produce uw us ® of the property uafaed to produce income. 1 - ly- l9-�03-D0 0 . asq -OO�o PROPERTY OWNED BY County Township County Tawrvship I hereby certify the above statements are true, correct and complete. Sig re of claimant and ZlPcode / ©,� 7 f rp Address lnumbera 18c2 r Lg ASSESSOR USE ONLY Ir 7RUE TAX VALUE ASSESSED VALUE I HOMESTEAD NON-RESIDENTIAL land not exceeding 1 (one) acre Immediately 1 L ,•{•, u'f a'` £Y surtoundin residential improvements. Other land (2) ,„ . },;r•:.:: Total land (line 1 plus line 2) (3) Dwelling (4) £ ri Residential improvements or Annually Assessed Mobile I Manufactured Home Garage `v° :'sxf -k•� =; (5) Other improvements (6) A4, r ax. Total Improvements (line 0 through line 6) (7) Total value (line 3 plus line 7) (8) I hereby certify the above is true, correct, Signature of Assessor Data signed (month, day, year) and complete. Verifying aeon - Signature of Auditor Data signed (month, day, year) r . • r r r 20 pay 20 Lesser of 60% of the assessed value of the homestead or S45,0D0 Nohvhhsardag any other provision, the win of the deductions provided in IC 6-1.1-12 to a mobile home that is S not assessed as reel property or to a manufactured home that is rat assessed as real property may not exceed one -had (12) of the assessed value of the mobdo home or manufactured home. Signs re of Audttar Data signed (month, day, year) FIFA Ell