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1.7,n;. CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
Wit::: STANDARD/SUPPLEMENTAL DEDUCTION
- "+' --I State Fonn 5473(R12/6-09) l C l r )�
i„•/ ' Prescribed by the Department of Loral Government Finance I 1 Mr I
INSTRUCTIONS:See reverse side for filing instructions. - APR 2 9 2013 girl' CERTIFICATION STATEMENT®. I(We) ! \ ♦ � Orr-
•incertify that y,:,y..•ibu r y(our)
. place of residence or am(are)buying the followin!described real property for which a Homestead PmperteT9pp t't' -.I .:.'Aw Maimed
under d on the date this application is filed, (date of filing):
(We)own ❑ Am(are)buying under recorded contract
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❑ Am(am)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•--. (legal name)
• - n
Name of claimant's spouse(legal name) • .
Social Seauity number of claimant's spouse(last five dgts)I Drivers license I Identification/Other number Issuing State
of claimant's spouse(last rive dkats)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded • Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
('�l ;r.,�l 1pa_r�Jiry��7robe Legal description Is the property in question:
/l.s�l r� 1• �� �I. ��1�CC ❑Real property ❑ Annually assessed mobile Mme(IC 6-1.1-i)
C�C� If any portion of the residential structure or the land not exceeding one(1)ace that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
' County Township County Township
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I hereby certify the above statements are true,correct and complete. Slgnatu[)•1 claimant
rr
/s `SA _ . S. -
Address( umber and street,city,state,and ZIP code)
t i 0 1 a • 4 / C I.
a A 61 1
ASSESSOR USE ONLY I TRUE TAX VALUE I ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
AT 100%OF TTV VALUE VALUE
Land not exceeding 1(one)acre immediately - err y'y,r -", 4.
surrounding residential improvements. (1) 1.-`d ?3 ?`-.v. A -''.0 sx
Other land (2) h
Total land(line 1 plus line T) (3)
Residential Improvements or Annually Dwelling (4) j1, gyAf`ty
As ced Mobile/Manufactured Home 2' S.'' s"- fi>iP 3` `
Garage (5) tin: <rs .G` `aC
n
Other improvements (6) •'�,_�a
Total Improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
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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 _
Notwithstanding any other pmeision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $ �M1�
not assessed as real property or tea manufactured borne that is not assessed as mat property may not exceed I '
one-half(1R)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year) .