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4-4;4; ,� CLAIM FOR HOMESTEAD PROPERTY TAX : ' .O it ;�. YEAR
,- STANDARD /SUPPLEMENTAL DEDUCTION '
i""' ll, State Form 5473(R12/6-09) - HCI0
*'' -4.1. Prescribed by the Department of Local Government Finance / t• 113
INSTRUCTIONS:See reverse side for filing instructions. .
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CERTIFICATION STATEMENT
I(We) /_�.. a_ /. -,-- �'�. certify that I(we)occupied as my(ou'r)principal
place of residence • am(are)buying the following described real property for which -/omestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (dal- 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
El 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 dartrregI(legal name) 1/47,r •
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Name of claimants claimants spouse�(leg�al,n,am_e)� 7 <
If buying on contract.Fee Simple owners name -
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Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
• County Township Taxing district(city,town,
Parcd number • al description 1. 504C. Is the property in question:
-20 PE $r''' _/ 0 ❑Real property _ ❑ Annually assessed mobile home(IC 61.1-7)
It any portion of the residential structure or the land not exceeding one(1)acre that Immediately surrounds that structure Is used to produce Income,descnbe the use and portion
of the property utlsed to produce income.
ato: 1 9 - n , 200 _ moo. 07 q- oZ5
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County I Township
I hereby certify the above statements are true,correct and complete. S'2 7 of daiman
Add - (number and street,-: ,state, ZIP e) Q X /
X 5:'4 S• •/ - (7 p&gnc t, '176V;
ASSESSED VALUE I HOMESTEAD I NON-RESIDENTIAL
ASSESSOR USE ONLY TRUE TAX VALUE I AT 100%OF TTV VALUE VALUE
Land not exceeding 1(one)acre immediately (1) 5,'Tf.r ..W `•;l'°-"sat' ,
surrounding residential improvements. ( ) s:.s �y.;._, a :-e.,._,.,_ ---..v
a;
Other land (2) " ,#� -', •
Total land(line.1 plus line 2) (3) •
9 (4) -y 24 iDg
Residential Improvements or Annually
Dwelling :�s'�__i• x��3.t�,F
Assessed Mobile/Manufactured Home Garage - tee-` a t'- ''`€4'E
Other Improvements (6)' rxl;` �Y
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Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus 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 Auditor, Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the asc csed 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 property or to a manufactured home that's not assessed as real property may not exceed
one-half(1,2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor �� � � _ Date signed(month,day,year)
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