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INSTRUCTIONS., See reverse side for riling instructions.
MATZ
FORM YEAR
0 i, I
certify that LRCM oct my (our) principal
place of resicimm or am ( e) buying the following described real property for which a Homestead Property Tax Standa4 leducli Is hereby claimed
CLAIM FOR HOMESTEAD PROPERTY TAX
(We) own ❑ Am (are) buying under recorded contract
STANDARD / SUPPLEMENTAL DEDUCTION
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
State Form 5473 (1112/6-09)
Nam no (legal nor i LA ant&JL
Prescribed by the Department of local Government Finance
INSTRUCTIONS., See reverse side for riling instructions.
MATZ
FORM YEAR
0 i, I
certify that LRCM oct my (our) principal
place of resicimm or am ( e) buying the following described real property for which a Homestead Property Tax Standa4 leducli Is hereby claimed
under cton the date this applicationisfiled, (date of filing): OIBSON COUNTY AU01TOR
(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
Nam no (legal nor i LA ant&JL
Serial Clacurity number
Drivers license I Identification
Issuing State
of claimant (last two digits)
Name of daimant's spouse (legal name)
Social Sewdty number of claimant's spouse (last five digits) Drivers license / Idenfification I Other number Issuing State
of claimant's spouse (last I" digits)
CONTRACT ••r
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY
County
Township Taring disbict (cny: town, township)
ante! r
Legal description
Is the property in question:
•
❑ Real property ❑ Annualty assessed mobile home (IC 6- 1.1 -7)
If any portion of the residential swuwre or the mod rfbt exceeding one (1) acre that immediately surounds that structure is used to produce income, describe the use and portion
' of the property ufif¢ed m produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true, correct and complete.
Sgnaturee I ai I '
Address (number street, city, state, and ZIPrwde)
L
ASSESSOR USE ONLY. TRUE IALUE ASSESSED V/.LUE
TAX AT 100% OF 71V
HOMESTEAD
VALUE
NON-RESIDENTIA
VALUE
Land not exceeding 1 (one) acre immediately
t`'`i"^'
sumountlin residential improvements. (1)
°+•''�� =3"k
(2)
Other land
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Horna
Garage
(5)
Other improvements
(6)
!f ✓t"
Total Improvements (line 0 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct,
Sgnanue of AS essor
Data signed (month, day, year)
and complete.
verifying action - Signature of Auditor
Date signed (month, day, year)
STANDARD • r
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
... -
Notwithstanding any other provision, the won of the deductions provided in IC 6.1.1 -12 to a Mobile home that is
$
not assessed as real property w to a manu/acturad home that is not assessed as real properly nay not exceed
one -hall (12) of the assessed value of the mo6te home or manufactured home.
Signature of Auditor
...
Dat®iigned tnanlh. at)