Homestead_Rahman d . art- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD /SUPPLEMENTAL DEDUCTION FORM
7 ..• State Form 5473(R12/6-09) . HCIO
°C,i„` Prescribed by the Department of Local Government Finance -
INSTRUCTIONS:See reverse side for filing instructions.
. .
' CERTIFICATION STATEMENT
iii to...^ I(We) !■.. . ( Mai •r♦.!I♦ c- - we)occupied as my(our)principal
place o residence or.1 are)buyin.re following described real property for which a Homestead Property Tax lg�gpnuda a 4Qn is hereby claimed
and contract on the date this applica on is filed, (date of filing): HI 1`
I(We)own ❑ Am(are)buying under recorded contract c.'3.nA,.tr�
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation v
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified persona re t ike j{CITOR
• •
CLAIMANT'S INFORMATION
If burying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
I PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Parcelzumber I Ley_._ ! Is the property in question:
a, —0 ar�V 900 — 003- a(60' l ❑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,describe the use and portion
\) of the property utilized to produce income.
S `tOt I - HO 6-‘ 1 Pt,
( PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County I Township
I hereby certify the above statements are true,correct and complete. Si.natur d ant f
Address(number and street,dry,stare,and ZIP code)
4 . 1,3 - -S 1 Ed 6d /7 z./c..7c.‘ —27-2- 76 Y
ASSESSOR USE ONLY I TRUE TAX VALUE I AAT 100%OF TTV I 'iHOVALUEAD I . NON-RESIDENTIAL
Land not exceeding retsdlately � xFtit :
surrounding residential improvements. (1) R,,
Tz{$Other land (2) r 1 j eyj
Total land(line 1 plus line 2) (3)
Dwelling (4) •-`°ai s �i'a+3=- i+1riiry'
Residential improvements or Annually
�:cm== v-x'a=T> 's- +•r•'=`°5
Assessed Mobile I Manufactured Home - ue -a i .'r;,xy s t.Garage (5) rT
Other improvements (6) 'h:-..:y;-71-,s•i_-M
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)
O STANDARD DEDUCTION ALLOWANCE - .
•
I20 pay 20 Lesser of 60%of the assessed 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 is not assessed as real property may not exceed