Homestead_Flusche I
CLAIM FOR HOMESTEAD PROPERTY TAX t1, STANDARD /SUPPLEMENTAL EDUCT N 1 1 �j FORM YEAR
�3?`q°( , State Form 5473(R13/12-09) HC10
Prescribed by the Department of Local Government Finance NOV 2 0 2012
INSTRUCTIONS:See:averse side for filing instructions.
1: 1- ia/`,i:_t,-.t1?�, l.AK-4-R-4:Aile v ,2rfb�a CERTIF;CATION}STATEMENT-rppay $teif-4-tti '.t� e�sT`iL x+i„e"A'r Tr t. 4
I(We) C i,p d\ °., .Ca 1-� F \ 4Ics6N k3OGf4TY AUD•'6(Y that 1(we)occupied as my(our)principal
place of residence or am(are)buying 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
❑ An(are)entilled 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
❑ Am(are) the shareholder, partner or member of the entity that owns the property.
(- i'-t -'••e'F ti�:y4v `:3u}'' .,..`r'trt`U..s'.�13.te., * Cl%MANT S INFORMATION„ �_:e e;t rrt�altirr,:fys,F.'" t�,.,S d..��l-`-�.a..=.'3. aj...t ..-�13
Name of claimant(legal name)
C-hr FIusc_Re
I of claimant(last five digits)
Name of claimant's spouse(f (name)
2 k-
I 1h
n ( G 1 / 5 C I1
•
If baying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
'1'rnPRO_PERTY'DESCRIP.TION^sF., is osazio,..- a'-. .::#r-z ti ' at.44K3-i-
County Township T • district(say,town,township)
rVi /
Parcel number Legal description Lv Isla property in question t(` Ct."4 CI 13 /I '1 Real pnysem ❑ Annually assessed mobile horse(/C 6-1.1-7)
If any portion of the residential structure or the land not exceeding dna(1)acre that birnSpiately sunou ds that structure is used to produce income,descnie the use and portion
of the property utilized to produce Income.
9) 6— oa 9- 2_60 - coo . 3oq -a19
4ia •� .ifst-t ,t;a. „fr,<s-'.-os::, a-�.3v.PROPERT,Y;OWNED'BYCLAIMANTcIN OTHER�COUNTIESy.V�_�sgrC^�;; t.- Lr,-,�,-�,.,�S�a,, v_ii..,,
County Township • County Township i
I hereby certify the above statements are true,correct and complete. Signature of claimant
Address(number and street,city,state,and ZIP code)
•F -':° s-s 1 - - "'ot:a *';? -i`h,,. '+ r ASSESSEDVALUE:-t'�HOMESTEADI`c }ti"'�- NONRESIDENTIAL a'�
�7;r"?`=1.r „ASSESSOR-USE ONLY .y+ti BSI TRUE T VALUE,tIrAT.:100/o OF TTVI .t2"tVALUE 3."t` s 2-FC4r 24VAL'UE az_ i<1
Land not
nding exceeding side t(one)acre ens. t1)surrounding residential Improvements. (1)
Other land (2) s.Ca '„5.,.,
Total land(line/plus line 2) (3)
Residential Improvements or Annually Dwelling (4)
Assessed Mobile/Manufactured Home Garage (5) rg � 2 'rx
Other Improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 phs line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Data signed(month,day,year)
and complete.
Veifying action-Signature of Auditor - Data signed(rinds,day,year)
1*-W A T fiZir.3 r s.,3... r;L.. ..,r??. -51 , STANDARD_DEDUCTION;ALLOWANCEi:61of' ' '`..'y$,ae;z1n..yA-Vin?ib iS i .-•i
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Nohvilhstarsding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real properly may not exceed
one-he(1/2)of the assessed value of the mob&home or manufactured loose.
Signawe of Date ` �day,signed