Homestead_Mightr ^•n
CLAIM FOR HOMESTEAD PROPERTY TAX
_ . STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R1216-09)
•O ,,,, 1 Presor bed by the Department of Loral Government Finance
J
C
l
INSTRUCTIONS: See reverse side for riling instructions.
' F All I j
MAR 2 5 2010
V
CERTIFICAT10N STATEMENT
I (We) certify that I e) ot"ied as A (our) principal
place of residelace or (are) buying the I&wing described 01 property for which LHomestead Property 1QI re0FjW3 Mn4iK*TGfdaimed
under contract on the date this application is filed, (date of filing):
(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
Name of imam (legal name)
If buying on contract, Fee Simple owners name -
Recorders office where contract is remmed Record number Page
PROPERTY DESCRIPTION
County
Township Taw district (city, town, township)
Parcel number
Legal description is tM2Xper1y in question:
L ^ {.�
— Oka LyKal property ❑ Annually assessed noble home (IC 61.1 -7)
If any portion of the residential structure or the WM not exceeding one (1) ace that immediately stmound that structure is used to produce income, desaibe the use and portion
the to income.
of property uofzed produce
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Courtly Township
County Township
I hereby certify the above statements are true, correct and complete.
grature omant
dress (number and street, city, state, and ZlPcode)
Boa E z �o g s +• l C1 z L476LOO
ASSESSOR ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD NON-RESIDENTIA
Land not exceeding 1 (one) acre immediatety
surrounding residential improvements. •. r f,.-= ;- rii}X.a/$
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)sy.Fr�'�.?
-"+"x i 4jr4� (�
3• t xE'r' +`d=° F
Residential Improvements or Annually
Garage
(5)
Assessed Mobile I Manufactured Home
Other improvements
(6)
i'a dTr �CFi
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
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
STANDARD r r •
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any oMerprovision, the sun of the deductiorss provided in IC 61.1 -12 to a mobile home that is
S
rat assessed as real property or to a manufactured hone that is not assessed as real property may not exceed
oneJoff (12) of the assessed value of the mobile hors ormanufactured lame.
S n ure of hditor I
Date signed (rtanth, day, year)
V