Homestead_Allen4
_4
4 CLAIM FOR HOMESTEAD PROPERTY TAX FORM veAR
STANDARD / SUPPLEMENTAL DEDUCTION HC10
State Form 5473 (R1216-09)
•S Prescribed by the Department of Loral Government Finance gg
INSTRUCTIONS: Se verse side for fifing instructions.
'I (We) certify that I (hm�Qcr,)rpi�d a i m�(our) principal
place of residence or am re buying the following described real property for which a Homestead Property Tax Ste ys pfd ti emby claimed
under contract on the dot is 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
G�xIBSO�f f�fftU��
❑ Have a beneficial interest in the trust or the right to occupy the property under the teens of a qualifiedperson% fasfAMleytr"DITOR
CONTRACT.RECORDED
It buying on contract, Fee Simple owner's name
Recorders of5ce where contract is recorded Record number Page
PROPERTY
County
Township Taxing district (city, town, f
umber
Legal description
Is Ne Pmpedy o question:
/r�1
Property ❑ Annually assessed mobile home (IC 6- 1.1 -7)
.eny Portion of the residential structure or the land not exceeding one (1) acre that immediatety sunounds t sWCNre is used to produce income, describe the use and portion
(the property utilized to produce income.
PROPERTYOWNED BYCLAIMANTIN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true, correct and complete-
natur
claimant
Address {number and street, state, and Zip code)
/ I S U
HOMESTEAD NON-RESIDENTIAL
ASSESSOR USE ONLY TRUE TAX VAL�E AT-100% OF TTV I VALUE VALUE
Land not exceeding 1 (one) acre immediately
1
s. "«'•.'�- �''ia`u*"s
residential ion roveenl ()
surrounding m
Riyi;z':
Other land
(2)
y'x,
Total land (line 1 plus line 2)
(3)
'r ''file
Residential improvements or Annualty
Dwelling
(4)
y �. �s 3,.� �•! A._a ^j;;
Garage
�!- %,' <"y
Assessed Mobile I Manufactured Home
(5)
xeT•x'.1M3:a5Fr:
Other Improvements
(6)
a �r
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(B)
I hereby certify the above is true, coned,
Sigralure of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signature of motor Data signed (month, day, year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Notudhstandirg any nine, provisos, the sum of the deductons provided in IC 6-1.1 -12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
an (1R) of the assessed valu e of the mobile home or manufactured home.
pr's
r /p/d}m —o {P�
Date s'g(V 1
VJony 1 V