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CLAIM FOR HOMESTEAD PROPERTY TAX
i ._ STANDARD / SUPPLEMENTAL DEDUCTION
Suite Form 5473 (R12 / 6.09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See neverse side for filing instructions.
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CERTIFICATION STATEMENT
I (We)
rtify that I (we) occupied as my (our) principal
place of residence or am r ) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the da is application is filed, (date of filing):
K(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 terns of a qualified personal residence trust
INFORMATION
Name of daimant (legs me)
Social Seamy
name)
Social Security number of daimant's spouse (last five digital Drivers license / Identification /Other number
Issuing State
of daimant's spouse (last five digits)
CONTRACT ••r
d buying on cenbac4 Fee Simple owners name
Recorders office where contract is recemed
Record number Page
PROPERTY DESCRIPTION
County
Township
Texkg ism (co' o
, / ip)
Parcel number
L al descriP Is the property in question:
� Real property ❑ Annually assessed mohlle horse (IC 6- 1.1 -7)
H any of the residential structure or the WrW not exceeding (1) ace that immadlately wrrou t eo =.m o used to produce Income, describe the use and portion
of the rty ueT¢ed to produce income.
PROPERTY OWNED BY
County Township County -
Township
I hereby certify the above statements are true, correct and complete.
Sig; f dey rma
Ad ss rQberan 1 $aQ `
„ -
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE
HOMESTEAD
NON-RESIDENTIAL
AT 100% OF TTV
VALUE
VALUE
Land not ezceedire 1 (one) acre immediatety
(t)
surtoundi residential improvements.
;i �. +'•"'`_ . ,,. raiF•Fti,
Other land
(2)•#;
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Garage
(5)
s;
2 � �7{8
Assessed Mobile I Manufactured Home
Other Improvements
(6)
l
Total Improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(6)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
verifying action - Signature of star
Date signed (month. day, year)
STANDARD • r
20 _ pay 20 Lesser of 60% of the assessed value of the,homestead or $45,000
Notwithstanding any otherproNsion, the sum of the deductions provided in IC 6- 1.1 -12 to a mobile home Main
$
not assessed as mal property w to a manufactured home that's not assessed as mat property may not exceed
one-half (12) of the assessed mfue of the mobile home or manufaWred frame.
Signature of Auditor
Date signed (nxmth. day, year)
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