Homestead_BarnettCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD / SUPPLEMENTAL DEDUCTION Hcfo
State Fonn 5473 (R131 12-09)
a,. Prescribed by the Department of Local Government Finance v
INSTRUCTIONS: See reverse side for filing instructions.
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I (We) certify that I (we) occupied as my (our) principal
place of refidence or am (are) buying the following described real property for which a Homestead Property Tax Standard p" 6 rye, claimed
IVIHI �tl [UI[
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—der contract on the date this application is filed, (date of filing). I (We):
0 Own E) Am Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as atenant- stockholder of a cooperative housing corporation VVV
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified persong1 CeQN61TY AUDITOR
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
Name of nt (legal name)
Social ly ra fiber of daimant (tast five dg3s)
Drive /s license / Identification /
Name f claimant's spouse (legal name)
Social Security number of claimant's spouse (last five digits) Drivers license I Identification /Other
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
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County Township Tatting istrid (city, rown, township)
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Parcel number Legal description 3 4r.S 8
Is the property in question:
c� r r r
❑ Real property ❑ Annually assessed mobile tame (IC 6.1.1 -7)
1 any portion of the residential structure or the land not exceeding one (1) acre that immediately sLftmnds that structure is used to produce income, describe the use and portion
the property utiraed to produce Income. Ill N E //- 3-9 Y . 3.3,* L
p 00. 03 6 — 0 0-3
11 1 112 AllIFT 11 11111111611
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Township County
111,11 511
Township
County
I hereby certify the above statements are true, correct and complete. jg re of claiman
Address (number end street, city state and ZIP code) /
S. e/ C(f l 4 _7 (0e� 0
S S M / L ri c a c..t/ 02 a rl of r-3
Land not exceeding 1 (one) acre Immediately Y
surrounding residential Improvements. (1)
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile I Manufactured Horne
�Ms'' 3 '- -1'ia
Garage
($ )
Other Improvements
(6)
Total improvements (line / through line 6)
(T )
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Sgrianrre 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
Namilhstanding any other provision the sum of the deductions provided in IC 6r 1. 1-12 to a naN1e home Mat is $
not assessed as real property or to a manufactured home that is not assessed as reel pmperly may not exceed
one -hall (12) of Me assessed value of the m b& lame or manufactured home.
Signa-
Signature of ita
Date sgnetl (month, day, year)
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