Homestead_Willis (3)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
Ink! imm,
MAR 01 2002
I (we) 6 "aftin
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I (We) occupied as =ajac�of �re,,de�nce residence following described real property' for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CO NT RACT! RECORD
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
ziPRO-P-ERTY.-D-E-SC-RI-P,-TfdN';'�'
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County
Township
Signature
Taxing disuirt (city, to", township)
I 1� QkQ nz _11_4 C� ku
Parcel number
(2) k ( , - b ( ct c5c!)
Legal description
Is the property in question: i
1 (:1 Real property ❑ Mobile Homo (I.C. 6-1.1-7)
If any portion of the residential structure or the land not exceeding we (1) acre that immediately surrounds that structure is used to produce income, describe the use and Portion
of the property utilized to produce income.
-7:1 OF�CiVEfRTY6WhEC BYtaIMA?4tlk.'OTktFt*COtihTltS'i7`2!'*-�!Z OjL?s'� ` S,P,.
County Township
County Tavnship
I hereby certify the above statements are true, correct and complete.
Signature
;iand Is,,,, state 11 code)
-,:t�Z:l�,4t!g�rSTANDARD: DEDUCTION�ALLOWANCE
.-��.�RUE-.TAXX,.�j*
AS
'sSgsAd`,�dt
SE
-;HOMESTEAD'-'
-it' ON-RESIDENTIA
r1-r'_N1
$
AT 100%o
VALUE
Signature of Auditor
Land not exceeding 1 (one) acre immediately
3-
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
C: z _iX
44 3
Residential improvements
4z
Garage
(5)
Other improvements
(6)
Z ins -4
Tdal improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
-,:t�Z:l�,4t!g�rSTANDARD: DEDUCTION�ALLOWANCE
20_ Pay 20
Lesser of 1t2 Homestead
$
Valuation or $6,000
Signature of Auditor
Date signed
3-