Homestead_Wirey (2)CLAIM FOR HOMESTEAD PROPERTY TAX
s, _ STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R1216-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
l �
APR 2 6 2012
CERTIFICATION STP
I (We) � certify that 1(we) octopi s our) principal
place of residence or am (are) buying the following d & bed real property or ich a Homestead Pmperty "MWA966Q k bb- WoAWlB6TeMRdaimed
under contract on the date this application is filed, (date of filing):
❑ I (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 daiment (leg me)
Social Seauity number of damam (fad fire digits)
Drivers license /
,
Social"Sticamynumber claimant's sparse (last five dgds) Drivers license I Identifcaaon /
CONTRACT •
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township
a (rity,m
Or`•''
Parcel number
Legal description Is the property in question:
'
Real property ❑ Annually assessed motile horns (IC 61.1 -7)
If any portion, residential structure or the land not exceeding are (1) acre that immediately surrouplas Nat structure is used to produce income, describe the use and portion
®
of the property utgued to produce ircortre.
9
PROPERTY OWNED BY
County Township
Cwnry Io Nip
hereby certify the above statements are true, correct and complete.
Signature of claimant '
Address (number and street, dry, state, and ZIPcom)
L 1
%O G% Lourl AA �rh t- Sill �6
E• r, el
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE I HOMESTEAD NON-RESIDENTIA
AT 100% OF TTV I VALUE VALUE
Land not exceeding 1 (am) acre fmmedlately
() 'fir
surrounding residential ion rovements. � -,aY2� .r-•_.
Other land
(2)
"'�?
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annualty
Garage
(5) -
Assessed Mobile I Manufactured Home
x',.rd z3r'f= -.- .•�c`eSrl+ m
Other Improvements
(6)
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.
V-6n g action - SigwWm of Auditor Date signed (month, day, year)
®STANDARD
• r
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000
Nohwhslandug any otherprovision, the sum of the deductions provided in IC 61.1 -12 to a mabde home that is $
not assessed as real pmperry or to a manufactured home that is not assessed as real property may not exceed _ -
onehaff (12) of the assessed value of the mobile home or manufacured lame.
Signature of Nudity
Date signed (month. day, year)