Homestead_Kelle (2) •
': ,' CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
:1 STANDARD /SUPPLEMENTAL DEDUCTION
L.?:,-�1. State Forrn 5473(R12/609) HC70
Ste- I Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
a I t i !al.
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CERTIFICATION STATEMENT
I(We) f^ 1: r I d. v i ��7„ ' ce ' t .t I we)occupied as my(our)principal
• place of residence or am(are)buying the • - ' ! bed real property for which a Homestead Property Tax Stan ggductiqf jghereby claimed
under contract on the date this application is _ (date of filing): II -LLUU I L
❑ I(We)own ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation '-111167710.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of aqualifie• -en: ` 9{UDITOR
cil:� is.*•
CLAIMANT'S INFORMATION
Nam f claimant(legal name)
Name of claimant's spouse(legal name
Social Security number of claimant's spouse(last The digits) Dr
Nees Dees license/Identification I Other number Issuing State
of claimant's spouse(last five digits)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recordees office where Contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Parcel nu Legal description Is the property in question:
D6 a P-b g- 00-000. yes goo ❑Real property ❑ Annually assessed mottle home(/C 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately surrounds that struetire is used to produce income,desatbe the use and portion
of the properly utilized to produce income. -....atm.:60.
As A/ead
PROPERTY OWNED BY CLAIMANT Ii'OTHER COUNTIES
County Township County - Township
I hereby certify the above statements are true,correct and complete. Si•natu�-.im�am /o ' /2
Address(number and street,cttY.state,and ZIP code) V
I I ASSESSED VALUE HOMESTEAD I NON-RESIDENTIAL
ASSESSOR USE ONLY I TRUE TAX VALUE i AT 100%OF TTV VALUE VALUE
Land not exceeding improvements.Immediately •; .•� ti surrou d n residential t)
Other land (2) it i::.% 0*
il
Total land(line 1 plus line 2) (3)
4.9i,,-.1f
Residential Improvements or Annually g (4) a
Dwellin 4 • e,- 1 ,.-TtSx v & - T
Accnccnd Mobile I Manufactured Home Via't
Garage (5) � e a x s. k
Other Improvements A (6) ,i,il'a ittittist,
Total Improvements(line I through line 6) (7) •
Total value (line 3phs line 7) (8) .
hereby certify the above is true,correct, Signature of Assessor Data signed(mourn,day,year)
I and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Leccpr of 60%of the ascpcsed value of the homestead or 845,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-f.1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one-hall(7R)of the assessed value of the amble home or manufactured home.
Signature of Auditor Date signed(month,day,yew)