HomeMy WebLinkAboutHomestead_Hartley (3)" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
State Forth 5473 (R73112-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
Flas
MAR n Q 'mi,
I (We) 2U certify that I (we) pMted'a gly�(our) principal
place of residence or am (are) buying the following ascribed real property for which a Homestead Property Tax Standard Deduction is,hereby claimed
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ter contract on the date this application is filed, (date of filin I e : V I"SON COUNTY AUDITOR
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
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
•-
Name of claimant (legal name)
S
Social Seauity number
Social Security number of clainant's spouse (last five tlgis) Drivels license / Identification /Other number Issuing State
of claimant's spouse (last five digits)
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number
Page
•.
County
Township Tatty district (city, town, township)-
Parcel number
L
escniption
Is the property in question:
r_WWI property 1:1 Annually assessed mobile home (IC 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acne that immediately sturcund that structure is used to produce income, describe the use and portion
of the property utilized to produce Income.
' �-5
•• e e:
County Township County Township
I hereby certify the above statements are true, correct and complete.
Signs f cla
Ad umber and sheet, state, and ZIP ST D /A /�
� Giv /'-
p ! Gam/ 7/�
c�Jyr- to
fir•
Land not exceeding 1 (one) acre Immedlatey
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surrounding residential Improvements.
(1)
Other land
(2)
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Total land (line 1 plus line 2)
(3)
Dwelling
Residential improvements or Annualty
(4)
Assessed Mobile I Manufactured Home
Garage
(5)
_
Other Improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above Is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month. day, Year)
ill 11 Jig . • • gi
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherprovisian, the sum of the deductions provided in IC 6-1.1 -12 to a mobile home that is
$
not assessed as mat property or to a manufactured home that is not assessed as real property may not exceed
one-has (12) of the assessed value of the mobile home or manufaWrmd home.
Signature of Auditor
Date signed (month, day, year)