Homestead_Chesire •
° CLAIM FOR HOMESTEAD PROPERTY TAX F t, YEAR
-.tV. STANDARD/SUPPLEMENTAL DEDUCTION
i i •
• .,i--1.- State Fonn 5473(R12/6-09) HCIBt
. O , Prescribed by the Department of Local Government Finance M I . - -
INSTRUCTIONS:See reverse side for fdaug instructions. • .'�, v� c
CERTIFICATION STATEMENT
I(We) 'iLyL,Il4i
2,.., I A �! -4 - t_ certify that I(we)occupied as my(our)principal
place of residence or am(a -f" 'ng the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the data /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
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
CLAIMANTS INFORMATION
Name of claimant(legal name) /46 (^'^L 'wK�
�_
Social Security number of claimant's spouse(last five dugds) Drivalicense o Identification I Other number
claim ant's spouse Oast five digits)) Issuing State -
CONTRACT RECORDED
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded - Record number Page
PROPERTY DESCRIPTION
.County Township Taming district(city,town,township)
Parcel number L aleg description Is the p erty in question-
// eel properly ❑Annually assessed mobile home(IC 6-1.1-7)
LIf any��of the to structure the land not exceeding one( )acre that immediatey surrounds that structure is used to produce income,desmbe the use and portion
•,26_/7 . 02.0.:-°2 00 - OO y / F3-0a/ .
yx,c„cC,
A. Ash yd." - 9 00 l00 - D O •
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township •
I hereby certify the above statements are true,correct and complete. 19nature of claimant /J`� _
K Address(number and street say,state,and ZIP code) r C '.C+n}/�nl/j�'
AP U/. 7 " S o_ _ v L z , '17'o
IASSESSOR USE ONLY I TRUE TAX VALUE AT E00%OF TTV I HOMESTEAD I NON VALUE
Land not exceeding 1(one)acre Immediately ?4 v„r, '''-'F �£.—'E' *m
surrounding residential improvements. . (1) .4 -.' "a=. 3-r -rf:?n.sa
Other land (2) 1- ,:* aw -
' Total land(line 1 plus line 2) (3)
xvv �.�,`p x��3 r v
Residential improvements or Annually Dwelling (4) rtt :3.!ariw{3
Assessed Mobile I Manufactured Home
Garage r, K Ar^, `�""hcTytp.. ;-
Other Improvements (6) t`'`• " '
Total Improvements(line 4 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 Anchor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20_ Lester of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions prowled in IC 6-1.1-12 to a mobile home that is $
not assessed as mar property or to a manufactured hone that is not assessed as real properly may not exceed
one-half(12)of the assessed value of the mobile home or manufactured home. -
Signao of Auditor ' / 1 Date signed(month,day.year)