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t CLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT /STANDARD DEDUCTION
` .1. State Forth 5473 (R5110 -01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instmclions.
I (We) ( ao fry (--T icy y r. f., '. ., certify
7 I (W, occupied as our principal place of residence the following described real property for which a Homestead
I (We) owned ❑ Are buying under contract
i 1 i •_
MAY 2 2W
a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
ff NTRACTRECORDEU. :`.
z
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
0,, ROPER xbMEC BY CIAIMXNT,. IN'OTFiER`COUNTIES'/'
County
Township
Taxing district , town, township)
P cel number
L descriptio
Is the roperty in question:
Zile
10g%OFTIV
>HO•
-'4z"`c VALUE
II-Real property ❑ Homo (I.C. 6-1.1 -7)
It any portion of the residential structure or the land not exceeding one (1) as that immediately surrounds thil structure is used to produce income, describe the use and portion
of the property utilized to produce income.
0,, ROPER xbMEC BY CIAIMXNT,. IN'OTFiER`COUNTIES'/'
County
Township
County Township
1 hereby certify the above statements are true, correct and complete.
Si a re t
^dress (number and street, city, state, ZIP code)
'
S
MT ATR D�3,
OU ENnT# IAL
O31tN AEASLI
0
, V,%;yM_
' .1..
10g%OFTIV
>HO•
-'4z"`c VALUE
r.
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Land not exceeding 1 (one) sae immediately
Valuation or $6,000
-v p3 ,f 3` pyt-•
surrounding residential improvements.
Date signed
Other land
Trial land (line 1 plus line 2)
(3)
"�.
Dwelling
(4)
0a
Residential improvements�rss'
Garage
ONO
(6)
N
Other improvements
(6)
�� s
AM
Total improvements (line 4 through line 5)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
11 T/ WDARDAEDUCTION' ' LOWANCE„7
I
aii `,4t..v1��-."fi'v"''Q.r'` -fsv.: Fes=
qW 20 Pay 20_
Lesser of 1/2 Homestead
Valuation or $6,000
Signature of Audhor
Date signed