Homestead_Chandler" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R1216-09)
'O ,•w / Prescribed by the Department of Laval Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
�0
( I�
DEC 2 8 2009
1 (We) certify that I ( e) as our) principal
place of residence or am (are) buying the follo ' g described real proRW for which a Homestead Property T@(&MIg(g dTaj4K four jg1jol"Oaimed
r contract on the date this application is filed, (date of filing):
I (We) own ❑ Am (are) buying under recorded contract
F
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 d i (legal nm
ae)
Social Searriry number of claimant's spouse (last rive digits)
Drivers license I Identification I Other number Issu'ug State
of claimant's spouse (fast the digits)
CONTRACT ••• .
If buying on cantrect, Fee Simple owners name
Recorders afire where contact is recorded
Record number Page
PROPERTY DESCRIPTION
Ceunry
Township
Taxbg dLmict (' for, township)
Parcel number
Legal description Is the property in ques r,
t—
l 1 L6Zal property ❑ Annually assessed mobile tome (IC 6- 1.1 -7)
any portion of the residential stnatum or the Wed not exceeding one (1) acre that immediately sunci n& that sin cane is used b produce Income. describe the use and portion
We
f the property utif¢ to produce income.
PROPERTY OWNED BY
County Township
Ccunry Township
I hereby certify the above statements are true, correct and complete.
S' nature of da', n
Address (number and street, city, state, and LP code)
!Sa c'. Mr:Ror3 S oit'D 476G(o
,. USE ONLY r r NON-RESIDENTIAL
TRUE TAX VALUE.
- AT 100% OF TTV I VALUE VALUE.
Immediately
not exceeding 1 (one) acre Immediate
surroundin residential improvements. ())
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
•- >. - ^•- +'`.� -: �. -2+x.. -.-. 5..., +s tsive.
Assessed Mobile I Manufactured Home
Garage
(5)
'r'n + .� s 1; -Y.r "? "•
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying action - SignaNa of Auditor Dare signed (nronth, day, year)
STANDARD • r
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notmthstanding any otherpmvision, the sum of the deductions provided in IC 6- 1.1 -12 to a mobile home that is $
rat assessed as real property or to a manufactured home that is not assessed as real pmperfy may not exceed
one -hall (1)2) of the assessed value of the mobile home or manufactured home.
Signature of Audi r
Dew signed (month, tlay, year)