Homestead_YoungM
'i:
CLAIM FOR HOMESTEAD PROPERTY TAX ,�� YEAR
STANDARD /SUPPLEMENTAL DEDUCTION
State Form 5473 (Rt2 / 6-09)
S ! Prescribed by the Department of Local Government Finance 1
INSTRUCTIONS: See reverse side for filing instructions. APR 1 9 201
STATEMENT
—CERTIFICATION
1 (We) ( �' thaattll�(v"cgyIJ yRmy (our) principal
ccertrtiifLy
place of res nce or am (are) buying the following described re I p party for wh a Homestead Bi SA rai(SfanNdlaTrd Deduction is hereby claimed
under contract on the date this application is filed, date of filing):
�I (We) own ❑ Am (are) buying under recorded contract
❑ Am (are) emitted 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
(legal _
0 0
d claimant (la ' Rs)
D ' s license I Id tion I
Issuing State
claimant (last five digits)
ouse (legal name)
tdahmnfs
O YN Q
D LL.
of claimant's spouse (last five digits) Drivers license I Identifice' Other number Issuing State
of claimant's spouse (last five digits) %.
CONTRACT RECORDED
If buying on contract, Fee Simple owners name '
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township
Taxing district (city wn, township) `
Parcel number
at escription
la the property in question:
6
❑ Real property ❑ Annually assessed mobile home (IC 61.1 -7)
If any portion of the residential structure or the land not exceedug one (1) acre at immediately mounds that structure is used to produce income, describe the use and portion
of the property utif¢ed to produce income.
3a
`-'� -�L.J
aL;-(R o a ye 3
PROPERTY OWNED BY
County Township
County Township
I hereby certify the above statements are true, correct and complete.
ignatuy of claimant '
PdT (numberand sweet, dry, crate, and LPcode)
y
O C
I TRUE TAX VALUE ASSESSED VALUE a
ASSESSORUSEONLY
Land not ezce eding 1 one acre Immediately
surrounding; residential imp rovements.
Other land
(2)
Total land (line 7 plus line 2)
(3)
Dwelling
(4)
J
Residential improvements or Annually
Garage
`•`+`in+S'
Assessed Mobile I Manufactured Home
Other improvements
(6).n
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 Assesscr
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 oNarpmuision, the sum of the deductions provided in IC 61.1 -12 to a mobile tame that Is
$
not assessed as real property or to a mamdadured home that is nor assessed as real properly may not exceed
one-half (12) of the assessed value of the mobile home ormanufadured hone.
Signature of Ito
Dale signed (month, day, )car)