Homestead_Wortman • FILED •
4 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
�: STANDARD /SUPPLEMENTAL DEDUCTION MAR 2 S 2013 Ftc,o
State Form 5473(RI2/609)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS:See reverse side for filing instructions. G(g$ON COUOR
CERTIFICATION STATEMENT
I(We) e r" ✓..L�e rt X14 certify that I(we)occupied as my(our)principal
place of residence or am(ale)buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of tiling):
I(We)own ❑ Am(are)buying under recorded contract
• Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation / Roy / y 97
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
CLAIMANT'S INFORMATION
Name of claimant(legal name)
( n D L
itilji
Name of claimants spouse(legal name)
Social Security number of claimant's spouse(last five digits) Divers license/Identification I Other number Issuing State
of claimant's spouse(last Ova digits)
CONTRACT RECORDED
B buying on centred,Fee Simple owners name
Recorders office ce where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
•
Parcel number Legal description Is the property in question:
tQ
Real property ❑ Annually assessed motile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre That immediately surrounds that structure is used to produce Income,describe the use and portion
of the property utilized to produce income.
A &-1 SS-i3-yoy- oc, a -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true,correct and complete. Signawre. • ru°�''r�
Address(number and street,city,state,and ZIP code) >(/ •
ASSESSOR USE ONLY TRUE TAX VALUE 'ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
I AT 100%OF TTV ( VALUE VALUE
Land not exceeding t(one)acre immediately t.S 1
" 1
surrounding residential improvements. (1)
t ..iii
Other land (2) ,}r"L 'rt
Total land(line 1 plus line 2) (3) '
Dwelling (4) •
r, �..:.,.-Vry�gk',.�ynt<-
Residential Improvements or Annually 3 gF s4'� � '
Assessed Mobile/Manufactured Home Garage (5) .+-�, ..r x✓1--^rr %0 .
. Other improvements (6) rea ' y'
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (B)•
I hereby certify the above is true,correct, Signature of Acsrc•or Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(n,cnfh,day,year) i
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
.
Notwithstanding any other provision,the sum of the deductions 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
one-hai(I i2)dthe assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
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