Homestead_CulverC
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12/6-09)
Prescribed by the Depammnl of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FO YEAR
0
FEB 4 2011
C. 3.II'1_ -r9 —
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CERTIFICATION STATEMENT
I (we)
t� t
ce "Itify'Ijvbb s my (our) principal
place of residence or am (are) buying the following described real prope for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
1 (We) own L] Am (are) buying under recorded contract
A m (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
INFORMATION
Name of claimant (legal name)
t
Social Security minter of ' (last five dgis) Drivers ficense I IdenI fixation
Issuing State
o/ claimant (last (rve digits)
Name of claimant' pouse legal name)
G Ve
Social Security number of claimant's spouse (last five digits) Drivers license / Identification I Other num r
Issuing Slate
of claimants spouse (Iasi rNe dgits)
/ �Y
CONTRACT ••s r
If buying on contract, Fee Simple owners name
Recorders office whim mnvaa is recorded
Remit number Page
PROPERTY DESCRIPTION
County
Township
Taxing d' (city,
township
Parcel number
Legal desodp6on
Is the property in question:
'
d
❑ erty Real prop El Annually assessed mobile home (IC 6.1.1 -7)
11 any portion of the residential structure or the land not exoAdInIfOr e (1) as that immedately surrounds that strupune Is used to produce income, describe the use and portion
of the property utilized w produce income.
?0_16707
PROPERTY . BY
County Township I - County
To Wp
1 hereby certify the above statements are We, correct and complete.
Signature of claimant
Address (number and street, pry, state, and ZIP code)
ltl J IS I a J --Y
TI-j %4_11660
ASSESSOR ONLY TRUE TAX VALUE ASSESSED VALUE
I HOMESTEAD NON-RESIDENTIA
AT 100% OF TTV
I VALUE VALUE
Land not exceeding 1 (one) acre Immedlatety;r
(1)
qy� +gb
surrounding residential improvements.
Other land
(2)
(
,.r: ?? °
ey��'i7�>t
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
`a r_:y�j
Residential Improvements or Annually
+, >•
Assessed Mobile I Manufactured Home
Gara g a
(5)
(5)
'.�Yh`iit s�''�.
Other improvements
(6)
Total Improvements (line d through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is We, correct,
Signature ofAasessar
Date signed (month, day, year)
and complete.
Verifying action - Signature of Nudtw
Data signed (month, day, year)
STANDARD s s
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NotN7hstaMrtg any oarerpmvism, the sum of the deductions pmwded in IC 6.1.1 -12 ro a mobile hame that Is
$
rot assessed as real property or to a manufactured home that is not assessed as real properly may not exceed
one -half (1)2) of the assessed value of the mobile home or rtanufactured home.
-
Signature of Ito
Date signed (mouth, day, year)
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