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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
r - CREDIT /STANDARD DEDUCTION Hc�o
State Form 5473 (11817 -07)
•v •.,. '� Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instroctions.
I (We) certify that on the rr��1st day of March, 20_
I (We) occupied as our pri pal place of residence the following described real property for which a Homestead Prope,.44,G C" i� y 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 proper or gtm i 46r'& a contract.
A -..;: i - _CONTRACT. RECORDED.,. ,-.r - a- '_..,_ ,, _.r:`• v. _ ic. l -
If buying on contract, Fee Simple ovmer's name
Township
Taxing district (city, to:vn,
PKell number '�7q'a�I d/��scn Is the props m question:
,LLy
IXlD-pLLyvp�Tc.J`Y'� -v. tJ . /o -`-' `•' "q�,VFR1 -I property ❑ Mobile Home (IC 6- 1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that strutture is used to produce Income, describe the use and portion
of the property uUlized to produce income.
County Township
County Township
I hereby certify the above statements are true, correct and complete.
S a claimant r -�
2
+ress (number and street . state. god ZIPC �� O
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
- -
Other land
(2)
Total land (line 1 plus fine 2)
(3)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Dwelling
(4)
_ - -
- • -
Garage
(5)
- -
Other improvements
(6)
-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus fine 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed (month, day, year)
Verifying action - Signature of Auditor
Date signed (month, day. year)
pay 20
Lesser of 112
Homestead Valuation
W
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44,000 for 2008 pay 2009 41,000 for 2011 pay 2012 S
43,000 for 2009 pay 2010 40,000 payable after 2012
T7