Homestead_StraderCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
State Form 5473 (1113 / 12-09)
Pmorihed by the Department of Loral Government Finance
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INSTRUCTIONS See reverse side for filing instructions
FORM YEAR
HC10
F I X i F R N
',_ YiCERTIFICATIONfSTATEMENT
SIT
place of residence or am (am) buying the following desc—ribad mail �property for �which a �Hmestead P�mpmertyfi "Tax Standoar J Muction is hereby claimed
contract
J-•
■
AUDITOR
■ 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 ovans the property.
MP.
Driver's license / Idembfication
ant (Last r" diI
Social Security number of claimants spouse (last III digits) • Other
of dalmarits spouse, (last Jim digift)
�r•dPROPERT.YDESCRIPTION,e
-•'7i^ s""� 'r "<' i 7. '1 bz PROPERTY =OWNED'Bl';CLAIMAf:Ti1N
OTH Eli '.000NTIESrA
-y
1 T c' w ti Fs tw•
" z- Y�ASSESORUS..,.d
c-- v,.-.- LFO 4c
t
I- PSSESSED VALUE;I
� ,.i r
iy EN.t T1ALr -;,
NON RESL'IUDE
-s®F
,.
VESTEADSg
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Land not exceeding I (om) acre Immediately
surrounding mid entlef ImproverneInts..
Total land III I plus line 2)
Residentl2l lerpnOValiftents or Annually
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1 J;4'� ^: r��f.�f i8�'v:- + ?A`„s'M ik•w t1�"x 'y- STANOPF iY6EDU CTION'Aa6WANCEd.p��`„y`3��.�`S
r pay 20 60% of the assessed _ rrr
NotwWWarxiM any otherproVI the Wit, of the deductions provided in IC 6-1.1-12 to a mI home
not assessed as Mai property or to a manufactI tI that is not assessed as Mal property my not exc"d
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