Homestead_Montz $i is CLAIM FOR HOMESTEAD PROPERTY TAX E YEAR
e STANDARD /SUPPLEMENTAL DEDUCTION
5c,' +„' ,• State Form 5473(R12/6-09)
- I Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instnrctbns. - MAY 9' 2013
CERTIFICATION STATEMENT
I(We) i1/ Ii- ii.1 _L . certify that � e' y(�ou,r,),Principal
place of residence or am(are)buying the following d:4bed real property for which a Homestead PropetCyl$3$Qr foA (F aimed
under contract on the date this 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
CLAIMANT'S INFORMATION
Name of claimant(legal name)
(7/777
Name of dalant's spouse(legal name) _—--
Social Security number of claimant's spouse(last five dgits)I Divers license/Identification I Other number Issuing Sate
of claimant's spouse(last five digits)
• CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
•
PROPERTY DESCRIPTION
County Township Taxing dis - (ay,,town,township),
may.
Parcel number Legal desolation I Is the property in question: •
• 11,/teal 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 utifaed to produce income.
tiro— .4/02 7 900 -Y0? - cc
. ,- - -/00 000 -1/ -o a
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true,correct and complete. Signao�'of claimant
x� /4 erii
Addres3,(numoer rir,t strael.�I'_nd ZIP code)
ASSESSOR USE ONLY TRUE TAX VALUE I AAT ESSED VALUE TTV I HOMES VALUE AD I NON-RESIDENTIAL
Land not exceeding 1(one)acre Immediately rtrtk�- ''��'`�' q,r.` '°t'`v
surrounding residential improvements. (1) r..^•�--H-� :$ir,+��F•-._...,
Other land (2) ~ /r "
: r
Total land(line 1 plus line 2) (3)
Dwelling (4) 'nu� -xx. -+' Tirs
Residential Improvements or Annually, :°' r` ,yeY. , ''
Assessed Mobile!Manufactured Home
5fm i 7 '
Garage (5) ti_ 1 xw t x %
-
Other Improvements (6) `i.
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8) '
hereby certify above is true,correct, Signature of Asersor Date signed(month,day,year)
I and complete. .
Verifying action-Signature of Auditor - _- Date signed(month,day,year)
IV STANDARD DEDUCTION ALLOWANCE
20 /I pay 20 r 7 Lesser of 60%of the assessed value of the homestead or$45,000 -
Nolwith standng any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $
not assessed as mat property or to a manufactured home that is not assessed as real property may not exceed
one-half(t/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed day,year)
( �7/YZCP /0/0 c5 �d