HomeMy WebLinkAboutHomestead_Hyatt ", CLAIM FOR HOMESTEAD PROPERTY TAX YEAR•
ti - iA STANDARD/SUPPLEMENTAL DEDUCTION FORM
s '° State Form 5473(R12/6-09) HC10
';— Prescribed by the Department of Local Government Finance }'IT:,. i --
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INSTRUCTIONS:See reverse side for filing instructions - _ .
I D D ,
Vii__ CERTIFICATION STATEMENT
I(We) firm I�,'�'�� _ , certify that I(we)occupied as my(our)principal
place of residence or am(are)buying th I ollowing described real pro rwrty sforO A.•:• r'`'u'1•rTf. Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, tile N tiAUDITOR
❑ I(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.:-'` f F I . •
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Social Seauity number of claimant's spouse(last five digits)I Driver's license/Identification/Other number State
of claimant's spouse(last five digits)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name •
Recorders office where contract is recorded Record number I Page
' PROPERTY DESCRIPTION
Can Township Taxing district(city.to t p)
of `. `' r,
^ a
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Parcel number Legal desolation I Is t petty in question:
Q� –ICr .1/W–oa V
Real property ❑ Annually assessed mobile 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,descrbe the use and portion
, of the property utilized to produce income.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Cerny Township County I Township
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I,/h'ereby certify the above statements are true,correct and complete. tu f dai t n
yodress(number and street,city,staff,and ZIP code) rte- Xdlr_
o� •n! Si Ir....•
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ASSESSOR USE ONLY I TRUE TAX VALUE AAT E00%OF TTVE I HOMESTEAD AD I NON-RESIDENTIAL
Land not exceeding 1(one)acre immediately -5`"' �Yom..
surrounding residential improvements. (1) • S':a – "+fF=e a
Other land - (2) Ah 7k Y w:
Total land(line 1 plus line 2) (3) •Dwelling (4) } ` ,�
ry +.v om.# x:RaldenUal Improvements or Annually
Assessed Mobile/Manufactured Home _ ' k' F"�3 4
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T
Garage (5) a r �>% _,,--# xN s
yeelvia
Other Improvements (6) - ;r?. ,;`, . ytr.ts
Total Improvements(line 0 through line 6) (7)
Total value (line 3 plus line 7) (8)
hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
I and complete. -
Verifying action-Signature of Auditor Data signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 - pay 20 Lesser of 60%of the accecsed 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 properly or to a manufactured home that is not assessed as real property may not exceed
If(1R)of the assessed of the mobile home or manufactured tame.
Sig of Audi / /f Date signed(month,day,year) •