Homestead_Blake r: CLAIM FOR HOMESTEAD PROPERTY TAX FO YEAR
STANDARD /SUPPLEMENTAL DEDUCTION F _ !"i
s State Fonn 5473(R12/609) Y 777��� 1 i
\--ill-/ Presuibed by the Department of Local Government Finarce
APR 13 2013
INSTRUCTIONS:See reverse side for filing instructions.
® CERTIFICATION STATEMENT
et.,rv..• •1",,IPI
I(We) _ _ G($SONt(tRry19? j (our)principal
place of residence orC (are)buying the following described real properly for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the/.ate this application is filed, _ _ (date of filing):
® I(We)own ❑ Arn(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 ' nt(legal name)
Name of claimant's spouse(legal name) .
Social Security number of claimant's spouse(last five digits)I Driver's license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
•
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city.town,township)
(//(,/)
Parcel number - Pr description Is the prope in question:
P L or y / to /.3c.A-L ❑Real properly ❑ Annually assessed mo ore home pc 6-1.f-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
fpof the property utilized to produce income.
R CC)— 0X — tt7 —o° 're - 0° 3. /lab-o / 7
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I e b certify the above statements are true_correct and complete. S'• ere of claim
Address umber and sheet,dry,state,and ZIP code)
- /
I l ASSESSED VALUE I HOMESTEAD I NON-RESIDENTIAL
ASSESSOR USE ONLY 1 TRUE TAX VALUE i AT 100%OF TTV VALUE VALUE
Land not exceeding 1(one)acre Immediately (1) ;�;fa- y� ,=r+.,.;� �.�.`V-71.2.Vy
surrounding residential improvements. ( ) 'l 1 .g'i% < - -+r.-
Other land (2) ( ,• y`
•
Total land(line 1 plus line 2) (3)
Residential Improvements or AnDy Dwelling (4) t ip T?'�3--T'
Assessed Mobile I Manufactured Home `gtYT1<" e 3t,Garage (5) Rtit r r • .5enTta-
Other Improvements (6) '-51' .:, dhoti
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits 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 Audtor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the acseased value of the homestead or$45,000 -A
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $ (y\
not assessed as real properryatoamanu/Scored home that anot ecc rsed as real properly may not exceed I
one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signaaof Amato - Date signed(month,day,year) .