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Homestead_Smith (4) • • • f.a' . CLAIM FOR HOMESTEAD PROPERTY TAX RM d YEAR STANDARD 1 SUPPLEMENTAL DEDUCTION F� S :..`•: t'. State Form 5473(R72/fiOS) • C10 6 -1,2' Prescribed by the Department of Local Government Finance • • INSTRUCTIONS:See reverse side for Ring instructions. - APR 2 4 2013 IP CERTIFICATION STATEMENT • 1(We) , el( L . . certify :�T� �,� (W ) !� � . . � � �� a.,,,."i'-t•r s my(our)principal place of residence or f (are)buying the following described real property for which a Homestead Prot/mg°mteotitaittuctiaztocreay claimed under contract on the date this 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 . O 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 o)/yinuM(legal name) • "// " „ CONTRACT RECORDED . If buying on contract,Fee Simple comers name . Recorders office where contract is recorded - Record number Page • PROPERTY DESCRIPTION County Township Taxing district(city,town,township) number description l is perry cquestio question: JL 13"©I;3oo -Ooo••^y1� c the property ❑ Annually assessed mobile home(IC 6-1.1-7) 6 any portion of the residential structure or the land not exoeere w ng one(1)acre that Immediately surrounds that structure is used to produce Income,descnbe 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. c jture1 t - /y\ .a rI a dress(number and street,d0:state,and ZIP code)� Y7 G,&o iI f L� ( ...... "r I I ASSESSED VALUE I HOMESTEAD I NON-RESIDENTIAL ASSESSOR USE ONLY I TRUE TAX VALUE I AT 100%OF TTV VALUE VALUE _ Land not exceeding 1(one)acre immediately (1)surrounding residential improvements. ( ) ,t 4;- �-a....a'Thict`.i .:< Other land (2) ,$�`&;�sw Total land(line 1 plus line 2) (3) Dwelling (4) � 'c ,.t�` s',nv:e`�` k ?i Residential Improvements or Annually,___ Accecced Mobile I Manufactured Home Garage (5) tarna Wt" Other Improvements • (6) �a' y, 't - • Total improvements(line 4 through line 6) (7) Total value (line 3 plus line 7) (6) - hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)• I and complete. Verifying action-Signature of Mater Date signed(month,day,year) 0 . STANDARD DEDUCTION ALLOWANCE 20 pay 20 - Lesser of 60%of the accecced value of the homestead or$45,000 Notwithstanding any other provision,the sum of the deductive provided in IC 6-1.1-12 to a mobile home that is $ 14 not assessed as real property or to a manufactured home that is not assessed as real property may not exceed- -^ one-half(12)of the assessed value of the mobile home or manufactured home. Signature of Auditor _ _ Date signed(month,day,year) •