Homestead_Rasche (3)F,
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
6 State Form 5473 (R1216 -09) .
Prescribed by the Department of Local Government Finance
INSTRUCTIONS. See reverse side for filing instructions
•6 r �.p
NOV 1 7 ZULU
I (We) certify thaIQBQWce Q6* fCWWpal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ I (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 I (legal
6
Social Secrxdy rxxmEef of ' (Fast Ae dg3s)
Drivels lxrnse l Identfication I Other
Name of name) -
Sodal Se city number of daimanl's spouse (last five digits) Drivels license I Idendfxaticn I Other number
Issuing State
' of daimznt's spouse (last five digits)
CONTRACT ••.
8 buying an contract Fee Simple owners
Recorder's office where contract is recorded
Record number Page
PROPERTY
County - Township Taring district (miry, town. township)
Pa
num �/� /�(� Leg /ai d�e/sc�nption
I ,)l /�� :r{/• D 1-00/7 /
Is the property in question:
❑ Real property ❑ Annua�y assessed mobile txune (IC &1. f -1)
11 any portion of the residential structure or the land not exceedug ire (1) acre that anmedistely sunourMS thatYuraire is used to
of the property utilized to produce income. Vfir�L�n Produce income. describe the use and portion
IL�I
.S'o �. Sibpt
PROPERTY OWNED BY
County Township County Township
I hereby certify the above statements are true, coned and complete.
Signature f dalmanI -
1 Address (number and street, dry, state, and LP code)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE I HOMESTEAD NON-RESIDENTIAL
AT 100% OF TTV I VALUE VALUE
Lantl not exceeding 1 (one) acre immediately
surtoundi residential ion rovements.
Other land
(2)`„�:
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
e*.c?.YCt^aM1°R"�..s'•�1+
Residential Improvements or Annually
Garage(5)°
2-'A.
Assessed Mobile I Manufactured Home
Other improvements
(6) 1
Wi
1 - U C;
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 Plus lure 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, yeah
...•DEDUCTION
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstandi g any other provision, the sum of the deductions provided in IC 6-f. 1-12 M a mobile home that is
$
nor assessed as real property or to a manufactured home that is not assessed as reel properly may act exceed
on& had (1/2) of the assessed valrre of the moble home or manufartued home.
Signature of Aurr=
Data signed (ninth, day. year)