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• • FILE.-ALE 4') . •
�,ma-^ • CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} STANDARD/SUPPLEMENTAL DEDUCTION / Q ZUI3 HCto
j ' State Form 5473(R12/609) • m O •
• ."- ! Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. OUNTY AUDITOR
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/, /7 CERTIFICATION STATEMENT
I(We) L- NcQC) G o/. e. C) certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
® I(We)own `B Am(am)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 dabrant(legal name) -
L/,vdq G'o /den •
Social Security number of deferent's spouse(last the digits) Drivers license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
CONTRACT RECORDED
If buying on contract,Fee Simple miners name
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Recorders office where contract is recorded Record number I Page
PROPERTY DESCRIPTION '
County Township Taxing district(city,town,townshi r rn
Parcel number Legal description Is thy proeel perty in prope qurty estion:
❑ Annually assessed C °
(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,desotte the use a ion
of the property untied to produce income.
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cR 69- / _ 30 c� M -W7
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
.
I hereby certify the above statements are true,correct and complete. "r �` //
Addressaq .•r a•beet,thy,state,:nd IPcode) 4 r� /
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ASSESSOR USE ONLY TRUE TAX VALUE I ASSESSED VALUE( HOMESTEAD I` NON-RESIDENTIAL
AT 100%OF TTV VALUE I VALUE
Land not exceeding 1(one)acre Immediately ",is v'`�I 'b"w,<s"3„ �.`
surrounding residential improvements. (1) - r-- 'i$ . :z9"-€.:::.
Other land (2) TAfic4;F'L '},, i
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Total land(line 1 plus line 2) (3) _ ss
Residential Improvements or Annually Dwelling (4) :f.`.c,iy c s
Assessed Mobile I Manufactured Home Garage (5) . . A ,^.Y`�"t
�S�e hart.
Other improvements (6) "v+;43".�1` _�r7t7
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 aeon-Signature of Auditor Date signed(month,day,year)
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STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the ascnsved value of the homestead or$45,000 -
Notwithstanding any other pmvision,the sum of the deductions provided in IC 8-1.1-12 to a mobile home that is $
not assessed as real properly or to a manufactured home that is not assessed as real properly may not exceed
one-half(12)of the assessed value of the mobile home or manufactured lane.
Signature of Auditor Date signed(month,day,year)