Homestead_Oweni
CLAIM FOR HOMESTEAD PROPERTY YEAR
STANDARD /SUPPLEMENTAL D EDUC�L�ED n''
S C10 -
State Form 5473(R13/12-09)
,°1° Prescribed by the Department of Local Government Finance •
INSTRUCTIONS:See reverse side for filing instructions. MAY 10 2013
- _ - - _-.CERTIFICATIONSTATEMENT _ _ - . •
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I(We) ,)1 • 1 :.. , : •� certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real pry difivbpldlnE llTl erty Tax Standard Deduction is hereby claimed
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under contract on the date this application is filed, (date of filing). I(We):
(L_I 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
❑ Am (are) the shareholder, partner or member of the entity'that owns the property.
' > .. t =i i t a l NTS_INFORMATION ,_ .- •, :- .,', 15- , .
Name of claimant(legal name) cud F 0 toe-AS
Name of claimant's spouse(legal name)
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Social Security number of claimant's spouse(last five digits) Drivers license/Identification/Other number I Issuing State
of claimant's spouse(last five digits)
- '0.-.,: r CONTRACRECORDED,17 _ .. _{ .. - ..
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
,I
• : _ - - CIEROPERTY DESCRIPTION , - '
County Township Taxing district(city,town,township)
Parcel number Legal descript ^ �/1/ / I Is the property in question:
Ir--!' I YI \) Q. V A 1/a Ol 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.
OR L- 13 - Hk a6 \ 006 075 [ oo 5
- : _ . PR OPERTLI'sOWNED_BY-CLAIMANT IN OTHER COUNTIES -_ ._ - . -
County I Township County Township a
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Sig ture of claimant n
I hereby certify the above statements are true,correct and complete. r}'I re of _ �J� e. .)ivey"`-
•ddress number and street,city state.and ZIP code) '` I '/X 7 7 ��/
■ . hr o SS ' i l GDnt . 11 767 "
/ ASSESSOR USE ONLY _IlTRUE TAX_VALUE 1 ASSESSED T 10000/OFTTVE HOMESTEAD _I -°- - NON-VALUENTIAL- _
Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4)
Residential improvements or Annually
Assessed Mobile/Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
hereby certify the above is true,correct, I Signature of Assessor Date signed(month,day,year)
I and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
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STANDARD.DEDUCTION ALLOWANCE : -20 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 61.1-12 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-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)