Homestead_Coleman (2)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
State Forth 5473 (R13112-09)
Prescribed try the Department of Lori Govemment Firence
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
m 'gam certify tha� �W (e ncipal
1(we) G G
place of real rice w (are) buying the following described real property for which a Homestead Property Tax S n a D uctiohe by aimed
,let centract on the date this applicetion is filed, (date of filing). I (We):
❑ Am (are) buying under recorded contract MAR 28 2012
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 oempy the property under the terms of a qualified personal rL's2encT
F1 Am (are) the shareholder, partner or member of the entity that owns the property. V\ \
•• •.
Name of nt (legal
,.y7 -
/tf /1 / , -9
Social Ser nu of (
Social Security number of claimant's spouse (last live dghts) Driver's license I Identification I Other number
Issuing State
of daimant's spouse (last We dots)
If buying on contract, Fee Simple owner's name
Recorder's office where contact is recorded Record number Page
minty Township Taring (txfy, con wnship)
UN
Parcel number �e description n r - Is tie p party in question:
d
!p rr !� Real property ❑ Annua a mottle home (IC 61.1 -7)
If arty f the residenilal sWCture or the IarM not x inp aria (11 acre t,1 ep5su ds that stnuchure is used to pmduce'vtcome, describe the use and portion
/qt !�
of de utilized to produce Irma. 5(j .E'
x6-13 -1 cc' aisor�
County Township County Township
County
1 hereby certify the above statements are true, m ect and complete.
sg re of da' nt
Address (number and soeet, dfl: stale cud ZIP code I
�� L ^J��k'(�. l'�
-_"°'e
Land not exceeding 1 (one) acre immediately .,
F
surrounding residential Improvements. (1) k"> >' ^•-
urn
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
y�W
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
�'�' -� r� ' +"`:
Garage
(5)
•-€
Other improvements
(6)
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, )ear)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day,. )ear)
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherpmvision, the sum of the deductions provided in IC 61.1 -12 to a mobte home that is
$
not assessed as real properly or to a manufactured home that is not assessed as real property may rot exceed
-
one -hall 12) of Me assessed vahm of the mobile home or manufactured home.
Signature of Auditor
Data signed (month, day, year)