Homestead_Stewart (2)11
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CLAIM FOR HOMESTEAD PROPERTY TAX
e. ? STANDARD / SUPPLEMENTAL DEDUCTION
S V State Form 5473 (R12/6-09)
Prescribed by the Department of Local Government Rrance
INSTRUCTIONS: See reverse side for filing instructions.
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OCT 0 g 2010
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CERTIFICATION
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I (We) certify tti8l�t sJ`b@Q(Vj�Pqrrr`S'Iqurl�s ri,,ndpal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is�t here �7Y� aimed
contract on the date this application is filed, (date of filing):
,under
KJ I (We) own ❑ Am (are) buying under recorded contract
�rL�J 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 da' t (kga/ ante)
Social Security number (dst fire dg3s)
Drivers fxerae /Itlenuficetion/
Name of claimant's spouse (legal name)
Social Secumy number of claimant's spouse (last five digits) Drivers license / Identification / Other number Issuing State
of claimant's spouse (last five digits)
CONTRACT ••r r
d buying on contras, Fee Simple owners name
Recorders office where contras is recorded Record number
Page
PROPERTY DESCRIPTION
Township Taxi is (' , born, m i
Parcel number
Parcel
Legal description / / � � Is the mperty in question:
Real property Annually assessed mobile home (IC 61.1 -7)
f any of the residential structure w the land not exceeding wa ae mat imrtadiatey su cis that sWCNre a used m produce income, describe the use and portion
of me pent' ubTaed to produce income.
696 q /10
PROPERTY OWNED BY
County Township County Township
1 hereby certify the above statements are We, correct and complete.
Sign re of clpimant
Address (number and street, ' tate, and LPcode)
3 Co 5 Oct,
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ASSESSOR
r VALUE I
HOMESTEAD NON-RESIDENTIAL
Land not exceeding 1 (one) acre immediatety,
54
�.'--
surrounding residential improvements. (i)s'~'�^.-
ih��''
Other land
(2)s,'�g=
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Garage
(5)
+'s-„ •e t" '.,�W3'�!". 7%
man Y •.�-
Assessed Mobile I Manufactured Home
4f' «;'+`s ---:
Other improvements
(6)
rt "MI
Total Improvements (line 4 through line 6)
(7)
Total value (fine 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)
STANDARD r r
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
'
Abhvettsiandirg any otherprovision, the win of the deduchwa provided in IC 6- 1.1 -12 to a mobile home that is
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net assessed as rest pmpedy or to a manufactured home that is not assessed as real property may not exceed
one -hall (iR) at the assessed value of the mobile home or manufactured home.
Signature of Auditor -
Date signed (month, day, year)
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