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CLAIM FOR HOMESTEAD PROPERTY TAX
�._ STANDARD /SUPPLEMENTAL DEDUCTION
State Form 5473 (R12I609)
Prescribed by the Department of Local Govemmem Finance
INSTRUCTIONS: See reverse side for King instructions.
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CERTIFICATION STATEMENT
I(We) certify that lf( (WP11
place of residence or (are) buying the following described r property for which a Homestead Property Tax Sta7S a eduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ I (We) own ❑ Am (are) buying under recorded contract
❑ 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
7 �� //Ou
Soda) Seca ty
Social Security number of claimant's spouse (last five dgtts)
Dnvera license / Identification I Other number Issuing Slate
of claimant's spouse (last fire dglts)
CONTRACT ••r r
If buying on contrail. Fee Simple owners came
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township Taxing district (city, town, Township)
Parcel number
Legal description
Is the property I question:
❑ Real property Elk ..By assessed mobile home (IC 61.1 -7)
If any portion of the residential stncbrm or the land not exceeding one (1) acre that Immediately surrounds that Structum is used W produce Income, describe the use and portion
of the property utif¢ed to produce income.
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PROPERTY OWNED BY
County Township
County Township
I hereby certify the above statements are We, correct and complete.
ima C
SignaW f m
Address (number and street, db: sate, and ZlPcode)
s, w Y 3
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE I HOMESTEAD NON-RESIDENTIA
AT 100% OF TTV I VALUE VALUE
Land not exceeding 1 (one) acre immediately 'r 1s. °•' "mow° -'
(1)t:.`i�K.+T`-
surrounding residential improvements. e"..e?'s
Other land
25,�r'
�•
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
ti� YKLiF•
M1 IOU
Residential improvements or Annually
Garage
(5)
�it'4�s:��Sti��tit'�,.4`'4r� °_
Assessed Mobile I Manufactured Hama
t� >NSrA•�) t
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, yea)
and complete.
Verifying action . Signature ofAudtor
Date signed (month, day. Year)
STANDARD DEDUCTION
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
NolwithstaMug any otherprouision, the sum of the deductions prov sled in IC 61.1 -12 to a mobile hone that is
$
not assessed as real property or to a manufactured home that is not assessed as real pmperly my not exceed
on"If (112) of the assessed value of the mobile horse or manufactured home.
.
SignaWra of Auditor
Data signed (month, day, )ear)