Homestead_Falls (3)L 7
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CLAIM FOR HOMESTEAD PROPERTY TAX
n STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12/6-09)
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for fiing instructions.
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CERTIFICAT10N STATEMENT
I (We) ce g that that I (we) occupied as my (our) principal
place of residence or (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on Ne ate this application is filed, (date of filing):
❑ 1 (We) own ❑ Am (are) buying under recorded contract
p 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
Name 1 claimant (legal name)
Sturdy nuns damranl (last five di9b)
Driver's license / identification / Other number
issuing State
Social Security number of claimant's spouse (last five digits) Ddvefs license I Identification I
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CONTRACT •e
If buying on centred, Fee Simple owner's name '
Recorder's office where commit is recorded Recerd number
Page
PROPERTY DESCRIPTION
County -
Township
Taxing district Vey, town, township) '
Parcel number
I Legal descriptionr1�� G Is the .ypdpe rty in question:
Real property Annually assessed mobile home (IC 6-1.1 -7)
II any portion of the residential structure or the land not exceeding one (1) acre that imnredlately sunonlrWS that savcpue Is used to produce Income. describe the use and portion
of the property utilized to produce Income. 8 i/ r &—K
3
a &- IV19- 303- aao.2ti9 -oo 9
PROPERTY OWNED BY
County Township County Townstup
I hereby certify the above statements are true, correct and complete. !�
Si§rlatura7 °1 clair"ar't
Adpress (number and street, city, state, and ZIPCOde)
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ASSESSEDVALUE1 HOMESTEAD NOWRESIDENTIAL
ASSESSOR USE ONLY TRUE TAX VALUE AT 100% OF TTV VALUE VALUE
Land not exceeding 1 (one) acre Immedfatety
surrounding residential improvements. (f) A4
Other land
(2)
�'w
ti`yriz
Total land (line 1 plus line 2)
(3)
Dwelling
4
Residential Improvements or Annually
Garage
}.
Assessed Mobile I Manufactured Home
ar�'�?_s *.��W
Other Improvements
(6)f>
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(B)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signatue of Auditor
Date signed (month, day, year)
STANDARD s s
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwid,staudirrg anyotherprovtsion, the sum of the deductions provided in IC 6-1.1 -12 to a mobile tame that is
$
rot assessed as real emperty or to a manufactured home that a not assessed as real pmperty my net exceed
on"It (1/2) of the assessed value of the mobda a or manufactured home.
signatu d Auditor
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Date signed (month, day, year)
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