Homestead_Lance (3) Stab Form 5473(R13/72-09) I ,M I 91 .t I )
ot Presorted by the Department of Lncel Goverment Femme �h'� TT
two
INSTRUCTIONS:See reverse side for flog b'Sbuctidns. NOV 3 0 2012
.uC4 'E:i!:r:.itn.. -°- t , ._ 2s YY•. lrj_uAice..- 1%:CERTIF.ICATION:$TATEMENT r:"_.`�..i5 7:1• A -3 _.... '4
I(We) el'
certify that I'(we)ocatpied as . pal
place of residence or ern(: - buying the following des.led real property for which a Homestead Property Tax Sra j Ie3Q cc,he '.ijmRed
under contract on the date this appfivaton is filed. V Un I Y
(date of filing). I(We):
Own ❑ Am(are)buying under recorded contract
tg
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
Have a beneficial interest in the bust or the right to occupy the property under the terms of a qualified personal residence bust .
❑ Am(are)the shareholder, partner or member of the entity that owns the property.
ii;4 ° y'.^.al ¢.$_":y _.. ,r- -,_.. .. .:1e.all ANT SINF,ORMATION214:•C. sit,.-S'�4l• ; - - .sue•.. *1'}.'� i�- .-'::
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be:.� - - ..f-:'+.• r ^Si.+"r-aCONTRACTrRECORDED�t:- ... ,- :a�j;-=i�. 2E�. ... iz;':e;Si.
.h... '+<e: ��:.}_s , ,. -iiK>.:. .-...i.•v-. 'vim._._.... .. .... _ °:.'F r. ':i>�--. _ _.c!
if buying co corm-act Fee Simple owner's name - .. ..
Reoardees office where cwmaa is recorded Record number Pege
r
ti .>.F�`--<.Z .. }5` F"i.`.` .li e-a-.`itii%-`•,`r�P.RoPEPT:Y:DESCRIPTIOV .<M - r-:): r 1.`y....-:.C*::* . _ - :
Tm tang,.-,-. lowst • sru�
l
- t.�� ♦ : 00� —7 —/'I �l\,.. ,r± �•._II tom.. " . .. ,
' he property N vueso r � ). .
� •�d���6S�,,rrla�l�Y1 13eyLtl/ssaaii! 'e L '� r�• Real properly ®:AmuatY assessed mobee Ihane.(IC fir;i-7)
of the resident/structure or the lard • +••__..... • :f 1)sae that immediately sumou r.-• structure o used to r .the use and pot
dthe•PuoPertY�7ZSir�a.m� __,—_. ��v. a• •
t� mot.• .�. 4.
`' ;g-,: - rw.,x ia; ? .:,:P.KOPLHI:Y`Ol"JNED:BY CL-AIh7ANT'IN'OTMER•COUNTIESI.Vi tre".r._:. ,., , . `-e iii:=
Carat Township County Township
I hereby certify the above statements are true,correct and complete. Signs I
rah°;0# 4y cr 1-qNCe--
'1 Cv f1C∎M6i ''t/- X9/3/cCm, D cH-/ -. —Al y76Sd
` it ki:ip-,:NON-RESIDENTIAL, A:;:.:;i
Y x ;� - ASSESSORUSE ONLY "J-`. TRUErTA)( AWE- ASSESSED VALUE :7 HOPdESTEAD f
.: ..'r• .. . . :- ._. , .i"f' rx't - -.I�-. .. �. .I_AT.'100-hOFmTTV).L">7t.24.VAL'UEr -.+ .{.}.-.s 2_ =.VALUE r-_�..;.= {
Land not exceeding 1(one)we Immediately 5'°-. ,yam -5T•va"??`::�:F;°
surrounding residential Improvements. (1) ;• c-2.. '4.: tri.- .:S s: _
Other land (2) tfiValet:
•
Total land(line 1 plus line 2) (3)
Residential l nts or Annually Dwelling (4) '" _'.ti1-4ti'4le. '..a :•a a a:
Assessed Mob /aianudactined home Garage (5) „ 24 =1` alt:t
Other Improvements (6) fr-7W-:172tt'3!'�L''.-`_'
Total Improvements(lire 4 7NOugh line 6) (7)
Total value (Ilse 3 pha Ilea 7) (6)
I hereby certify the above is true,correct Signature 07 Assessor Date signed(r`�'dc�' .ea4
and complete.
Verifying edbn•Signature of fud±w Date signed(mmth,dal:year)
'r:::03, . 1::=1 ..1 i- : u . -'i. .AtA".. ST ANDARD.DEC.UCTIONALLOWANCE, ",.: 'C'o-.:,:r�•..:,<-_a ->, . ;4,. !:a_.!
20 pay 20_ Lesser of 60%of the assessed vane of the homestead or$45,000
Notettfistalefing anyarlher provision,the scar of the deductions po•ided in IC 6-1.1-12 to a mobie home that is $
not assessed as real property or to a manufactured home that is not assessed as real property may riot exceed