HomeMy WebLinkAboutHomestead_Rahman11
• 1
e
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
s State Form 5473 (R121609)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FORM YEAR
HC10
-r
CERTIFICATION STATEMENT
I (We) we) oceupied as my (our) principal
place o residence or are) m t e following described real property for which a Homestead Property Tax
g{ en Is hereby claimed
(�lyaprta�all
and contract on the date this applim ion is filed, (date of fflin Mal ` "�L
9)
I (We) own ❑ Am (are) buying under recorded contract C r�
❑ 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 �(g3DITOR
CLAIMANT'S INFORMATION
Name of t / name)
Social of dakn#A (last five digis)
Drivers license / Identification /
Issuing
of claimant (last five dgei)
Name of da 's spa
`
(legal name)
Social Security sa (last five dg4s) Drivers license / Identification /Other
CONTRACT RECORDED
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district (city, town, township)
P icel�umbe` Legal desttiP
Is the property in question on:
oo _
SL (,•6/
Real property ❑ Annually assessed n.We home (IC 61. 1-7)
II any portion of the residential structure or me land not exceed one (1) arse that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. '
,/^'
S-V I _I_IO �'V� • V
PROPERTY OWNED BY CLAIMANT
IN OTHER COUNTIES
County Township
County Towrahip
I hereby certify the above statements am true, correct and complete.
S' natu d t
O
Address (number and street, city: state, and ZlPoode)
Il it
ed .( 7G Yo
ASSESSOR NON-RESIDENTIAL
AT 100% OF TTV VALUE VALUE
land not a "ce" 1 (one) acre Immediately 1
residential improvements.
surtoundin O
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
's''si y43 cy°FSY
(5)
Other improvements
(6)
}^y_;q;,MM pi
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Data signed (MMM, day, year)
and complete.
Verifying action - Signature of Auditor
Data signed (month, day, year)
STANDARD
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NohWgrstandirg any other provision, the sam 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's net assessed as real property may not exceed
ona -ham (112) of the assessed value of the =&a home or manufactured tpme.
Signature of Auditor
Date signed (monfh, day, year)