Homestead_ColemanCLAIM FOR HOMESTEAD PROPERTY TAX
._,. STANDARD / SUPPLEMENTAL DEDUCTION
Stale Forth 5473 (R12/6-09)
'O I Presented by the Department of Loral Govemmem Finance
INSTRUCTIONS: Sae reverse side for filing instructions.
NOV 0 9 2009
CERTIFICATION
I (We) 011-1 certify that I (we}}IWR pNbdMR
place of reside r am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract a date this application is filed, (date of filing):
9I (We) own El 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 terns of a qualified personal residence trust
••
Name of da' I (legal name)
Social Seauily n of claimant (last rive dgds)
Drivers license I Identification /
Issuing Star
Of claimant (last rive digits)
Name of daimanYs spouse Uegal name)
Social Semmy number of claimant's spouse (last five digits)
Drivers license / Identification / Other number Issuing State
of claimant's spouse (last rive digits)
CONTRACT ••r r
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY
County
Township
T d 'a (city, wn, township) .
Parcel number
esaipti n
Is Ne
ro e question:
Pent ❑ Annually assessed mobile home (IC 6- 1.1 -7)
®If any con of the residential structure or the not exceeding one (1) acre that Immediately su n that structure is used to produce intone, describe the use and portion
of the party util¢ed to produce
--
-/d - 41- 0c).�o'fo -00%
PROPERTY OWNED BY
County Township County Township
I hereby certify the above statements are We, correct and complete.
daimam
Address (number ago street, tip: slate, and ZlPcods)
y/D PR'ni s7Pa� GKl4 Cf' U7(/Go
_TN
r . NON-RESIDENTIAL
ASSESSOR AT 100% OF
land not exceeding 1 (one) acre Immediately
surtoundin residential improvements.
Other land
(2)
;�e;_..�;�•�);; ?,��`'.�:
.
Total land (line 1 plus line I)
(3)
Dwelling
(4)i
r'a'4t'P�"wy-t£',
Residential Improvement or Annually
Assessed Mobile I Manufactured Home
-eE`,
Garage
(5)
3 'cam` M`d -�?.•
.x.' �t -�SKW •6 's •ns
Other improvements
(6)
Total improvements (line 4 through line b)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (amth, day, year)
and complete.
Verifying action - Signature of Audiw
Date signed (month, day, year)
STANDARD • r
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
'
Notwithstanding any other provision, the sun of the deductions proded in IC 6.1.1 -12 to a mobile lame that is
S
not assessed as real property or to a mamdactured hone that is not assessed as real property may rot exceed
one -hall (12) of Ne assessed value of the mobile home or manufactured home.
SignaWre of Auditor
Date signed (month, day, year)