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STANDARD CLAIM FOR HOMESTEAD PROPERTY TAX
/ SUPPLEMENTAL DEDUCTION
State Form 5473 (1112 / 6 Prescribed by the Department of Loral Govemment France
/❑- 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 nt legal name)
Social Sectlilry number of claimant (
Social Security number of claimant's spouse (last five dg4s) rivets license / Idenhfcaton I Omer number /
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bONTRACT RECORDED
It burying on contract, Fee Simple owners name
Remmers office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township Taxfig it (rAl: town, township}
UN
Parcel number
Le,da desengtion Is Ue
pony in question:
YJ c <iCj.
Reap property ❑ Annually assessed mob le home (IC 61.1 -7)
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any portion o1 residenual structure or the land not exceeding one (1) acre that amn s that strumure is used to produce income, describe the use and portion
of the u to income. G
property produce • / `J
�G- ao -oa -� /ern 3
PROPERTY r BY
County Township
County Towns hp
I hereby certify the above statements are true, correct and complete.
signature of Claimant
XAtldress
(number and sheep crty, state, a zVoode)
s • r • r
land not exceeding 1 (one) acre immediately
surtoundin residential im rovements.
Other land
(2)
= '•;?.c4
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
.12 w' '1 S'Le• -ti a4-s.��:
Residential improvement or Annually
Assessed Mobile I Manufactured Home
Garage
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Dow signed (monm, day, year)
and complete.
Verifying action - Signature of Auditor Date signed (month, day, year)
zi r • • 'j 01:111
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Notwilistandiing any otherpnwwcn, the wm of the deductions provided in IC 6-1. f -12 to a mobile lame that is S
Wt assessed as real properly or to a Manufactured home that is cot assessed as real property may cot exceed
one -half (12) of the assessed value of the mobfie home or manufactured home.
Signature of Auditor
Data signed (month, day, )ean
If