Homestead_Elpers" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 / 6-0g)
�' ,•,• •° Prescribed by the Department of Loral Government Finance
wsTRUCnoNS: see reverse side for filing lnstruclions MAY 1 1 1010
I (We) certify ma y (our) prindpal
place of residence or am (are) ng following escribed real property for which a Homestead Prope 7Taa &�Iaanda educU Is hereby claimed
`i'It3gON
COUNTY AUDITOR
under contract on the date this a icetion is filed, (date o /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
INFORMATION CLAIMANTTS
Name of da ill aim me)
Social nanbri of claimant (
Drivers license I Identification /
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Name nmM
Social Security number of claimant's spouse (last five dgifs) Drivers license / Identification I Other number Issuing State
of claimant's spouse (last five dgm)
CONTRACT ••• r
If buying on Conaact, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION,
County
Township
Taxing district
ip
Pamrel nurber
/yY_
Legal 3n -
Is Ne property' estion:
�( (l 7MI
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a property ❑ Annua %a
ode a (IC 61.1 -7)
any portion of the residential structure or the land not exceedeg one (1) acre that immediately surrounds that structure is used o produce Income, describe me use and portion
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of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Towwaship
I hereby certify the above statements are true, correct and complete.
r ctaimam
Ad mss (number and et, city, state, and ZIP Code)
2a Streale S�- �,+ SN g76G0
r r r
ASSESSOR USE ONLY TRUE TAX VALUE a I
Land not exceeding one acre immediate ny"w{� '�`�` '" -` f'"t' ' •'`• =
tY ( 1 ) dam^` •^4`�
surroundin residential tial im rovements. -'tk'
�}1k
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile l Manufactured Home
Ga2ge
(8)
s�'U� 'r^• a �,xd±�:m'.'"E
Omer improvements
(6)
Total Improvements (line 0 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Data signed (Comm, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (mmth, day, year)
r . • r r r •
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Nolvithstanding arty other provision, the sum of the deductions; provided in IC 61.1 -12 to a nmb&. home that is
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rot assessed as real property or to a mmulactured home that is not assessed as real property may not exceed
one-haiffpM o/ the assessed value of a mobHe home or mania u home.
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