Homestead_White (20) FTLEit
�,.�?. CLAIM FOR HOMESTEAD PROPERTY TAX f FORM YEAR
-A STANDARD/SUPPLEMENTAL DEDUCTION
I -.`::l:' AP@i ®1i 201
• State Fonn 5473(R12/6-09)
ii..- Prescribed by the Department of Local Government Finance ' .
INSTRUCTIONS:See reverse side for filing instructions. '
• COUNTY AUDITOR
)CE[RTIFICATION STATEMENT
I(We) / � //�(////JJ certify that I(we)occupied as my(our)principal
place of residence or am(are)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 filing):
En(We)own ❑ Am(are)buying under recorded contract
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 terms of a qualified personal residence trust
CLAIMANT'S INFORMATION
Name of claimant(legal name)
Social Security number of claimant's spouse(last five digits) Driver's license/Identification I Other number Issuing State
of claimant's spouse(last Me digits)
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CONTRACT RECORDED
If buying on contras,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(dry,to to V,�i.
I
Parcel number Legal ton Is�'7leJ''property in question: - --
4 I)j,�c) Pia rWS I property ❑ Annually assessed mobile home(/C 6-1.1-i)
If any portion of the residential stru ture or the land exceedi g one(1)acre that i ediately surrou that structure is used to produce Intone,desa to the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true,correct and complete. ,g 1a ire of claimant �J L,„/,tie„
Address(number and street,dry,state,and ZIP code) 5/^/ At �' / ,
ASSESSOR USE ONLY TRUE TAX VALUE I ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
I AT 100%OF ITV VALUE VALUE
Land not exceeding 1(one)acre immediately Ira -'^.+�."� ',-
surrounding residential improvements. (1) 'vim .4v?';3. -gi-:3�v.'.3
r
Other land (2) i-'r','4 ' �,££
Total land(line 1 plus line 2) (3)
Dwelling (4) Ar kw-a
r v* ,:KSyr sis- <.Residential Improvements or Annually
Assessed Mobile I Manufactured Home
X!"jLAi�4.-4W-- Y
;:
Garage (5) 1garp y� .s+iugd; .' c•t 7: r
Other improvements (6) • 4}53 s _4.44 io..
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
. and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 t�
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $ t``V\\
not assessed as real properly or to a manufactured home that is not acwcsed as real properly may not exceed
one-half(12)of the assessed value of the mobile home or manufactured home.
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Signature of Auditor Date signed(month,day,year)
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