HomeMy WebLinkAboutHomestead_Green (2)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
6 State Form 5473 (R1216 -09)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing instructions.
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CERTIFICATION STATEMENT.
I (Wa) rtrt� (wril r�oiarl aAl7 our) principal
place of residence or am (ar buying the owing described real pe or whi Homestead Property Tax Standard a uc con reMoY claimed
under contract on the date this application is filed, (date of filing):
9(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
Name of dawn em (legal name)
Secodry number of claimant V rive dgts)
DriveYS license / Identifical"- IOther number
Issuing State
Q.
Social Security number oroaunant 's pouse (la five digits) Driver's license / Identification i Other number Issuing State
of claimant's spouse (last rive digits)
CONTRACT ••. •
If buying on contract Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township Taring itistin city rown, township)
Parcel number Q
Legal description
Is the p perry, m question:
�eal
property ❑ Annually assessed mobile home (/C 61.1 -7)
jdalfany
potion of the residen0al sWCblre w the land no exceeding one (1) awe that immediately surrounds that structure is used ro produce income, describe the use and portion
I the property utif¢ed to produce income.
County Township County Township
I hereby celti y the above statements are true, correct and complete. v
- Sgnetu of daimant -
rl
..
Address (number and st t, arty, state, and ZlPcode) r
/766o
e) ro,m Immediately
u d nndin
re sidetieo
Other land
(2)
Total land (fine f plus line 2)
(3)
Dwellin g
(4)
ur-
Residential improvements or Annually
Garage
(5)
Assessed Mobile I Manufactured Home
Other improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 p /ts line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, yearl
STANDARD DEDUCTION ALLOWANCE
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
No Itu landing any order provision, the sum tithe deducMns provided in IC 61.1 -12 to a mobile Mme that is
$
rot assessed as real property or to a manufactured hone that is heir assessed as real property may not exceed
ore-haH(I/2) of the assessed value of the moede Mme or manufactured home.
Signature of Auditor
Data signed (month, day, year)
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