Homestead_White (2)i'� "'^ CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD
/SUPPLEMENTAL DEDUCTION
State Form 5473 (R121 &-M)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS. See reverse side for filing instructions.
T 11''i
IAId -ri %()in
CERTIFICATION STATEMENT
r
certify that I (vawpied uN (our) principal
place of residence or am (are) buying the following describ I property for which a Homestead Property Tax Stan rd on is�reby claimed
unde co ntract on the date this application is filed, (date olfiling): �)8�� wv RkiB1T6R
(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 oust or the right to occupy the property under the terms of a qualified personal residence oust
INFORMATION
Name of of an (legal name)
27=177
Social Security number
Social Security number
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County
Township
T strict � .town, ip)
i
Parcel number
Legal description I the p ny in question:
Rawl property ❑ Annually assessed mobile home (IC 6.1.1-7)
Ankif
any portion of the residential swcture or the land not exceeding one (1) acre that immediately surrounds tKal structure is used to produce income, describe the use and portion
Wthe
property utillmd to produce income.
PROPERTY OWNED BY
County 7ownship
County Township
I hereby certify the above statements are we, correct and complete.
Signs of claimant
Address number and street, city, state, and ZlPcode)
7'
•- NON-RESIDENTIAL
OF TTV VALUE VALUE
Land not exceeding 1 (one) acre immediatetyl
surrounding residential improvements.
Other land
(2)
-'' -•r
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Mnualty
Garage
(5)
y5s s_..''r?r
Assessed Mobile I Manufactured Mom a
n ram _i•`f
Other Improvements
6)
CT ,„'- �`- r"•- �?;=`- �A-.,_�•�� ^'�
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 pl s line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assess or
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherpmvisian, the sum of the deductions provided in IC 61.1 -12 to a motile home that is
S
Trot assessed as real property or to a manufactured home that is nat assessed as real property may not exceed
one -haH (12) of me assessed value of the mobile home or manufactured home.
Signature of Auditor
Date signed (month, day, year)