Homestead_Persinger_ .
CLAIM FOR HOMESTEAD PROPERTY TAX SRN
STANDARD /SUPPLEMENTAL DEDUCTION r(c�o1
State Form 5473 (R121609)
Prescribed by the Department of Loral Govemmenl Finance 1;
OCT 2 2 2009
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATiON
certify that{PX},ocafpF;Q 1RtgyX8dPfflwal
place of residence or EG (are) buying the following described real perry for which a Homestead Property Tax Standard Deduction is hereby claimed
unde ntract on the date this application is filed, (date of filing):
K1 (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 f daimant (legal
Social Seamy numbUot davrant (last five digds)
Driver's license I Identification
e of dauQani's s fp (legal namal
Social S rity number of claimant's spouse w five rites) Driver's lcense I Identification I
CONTRACT ••• -
If buying on mntraM Fee Simple owner's name
Recorders office where mntred is recorded Record number Page
PROPERTY
County Township Taring district (city, town, township)
Pamel number I it
Is Uhe pmPerty in question:
a•
❑ Real property ❑ Annually assessed mobile home (IC 61.1 -�
I any portion of the residentlal stucbure or the land not exceedi ne (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
I the property utd¢ed to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township Ceuny Township
I hereby certify the above statements are true, correct and complete.
Signs of claimant (\
\Y)
dress (winter and street, city, state, and ZlPcade)
41
ki
Land not exceeding 1 (one) acre immediatety 1ti--
( )
rxY'".�rs`"-— (�•- �-�gyf `'
SX..., x,..._.,.;n ..;, 5•. s
surrounding residential improvements.
_,. ,;•
a
Other land
(2)
t�-'
SF r.4..
Total land (line 1 plus line 2)
(3)
t•' M1Y'WZ�r7tr
Residential Improvements of Annualty
Assessed Mobile I Manufactured Home
DW2111n g
/l
( )
' { Q ss'b-szr } Y 74h
r
b'"i •+,# 5`•'
ra
Gage
(5).e;x
Other Improvements
(6)
43 a
Total improvements (line 4 through line o)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor Date signed (month, day, year)
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any other prevision, the sum of the deduri ons provided in IC 61.1 -12 to a mobile home Nat is $
rot assessed as real property or to a manuladuiad home that is not assessed as real property may not exceed
one-half (1/2) of the assessed value of the mobie home or manufactured fame.
Signature of Auditor
Date signed (month, day, year)