Homestead_Barnett"' CLAIM FOR HOMESTEAD PROPERTY TAX
} STANDARD / SUPPLEMENTAL DEDUCTION
6 Stale Form 5473 (R12/6-09)
'O l Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
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CERTIFICATION STATEMENT
I (We) ceAity
at r) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax
St is hereby claimed
under ct on the date this application is filed, (date of filing):
Aar rDeduction
{{{{ nn / 2011
I (We) own ❑ Am (are) buying under recorded contract
C
❑ 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 Walifie(Q
nal residen
INFORMATION
Name of nt (legal me)
Social Seaaity number of
�+�gd' )
Drivers ficerue I Identification / Olt �
Name of claimant's spouse (legal name)
Social Seartity number of claimant's spouse (last five digits) Drivers license I IdenWication / Other number
Issuing Stale
- of claimants spouse (Iasi five dgits)
CONTRACT ••D
It buying on wnaact, Fee Simple owners name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County
Township Taxug district (city, town, township)
X- n r
Legal deson.ption
Is the property in Question:
O- ' aDO
QD 11
❑ Real propeny
❑ Annually assessed mobile hone (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 ' e, de use a
sQi ..
of the property uhTaed to produce income.
1A -mw
PROPERTY OWNED BY CLAIMANT
IN OTHER COUNTIES
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
9 t clat —,G
due (nuanberaM atreet, state, and ZlPcode)
K7S 3 r ;ccp �M K7,64
otic
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE I HOMESTEAD
AT 100% OF TTV I VALUE
NON-RESIDENTIA
I VALUE
Land not exceeding 1 (one) acre immediately
yv.T�,.,'ijg,'"v4•s3 �%s
`�•"x-
surtoundin residential improvements. (1)
xt_ R� -: t=c��,
ge°J••i1'
Other land
(2)
-'f�°
Total land (line 1 plus line 2)
(3)
Residential improvement or Annually
Dwelling
(4)
Mn'
Garage
(5)
Assessed Mobile I Manufactured Home
Other improvements
(6)
Total improvements (line 0 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is We, wrrect,
*natura of Assessor
Data signed (month, day, year)
and complete.
verifying action - Signature of Auditor
Date signed (month, day, year)
STANDARD • r
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherprovislon, the sum of the deductions provded in IC 6-1.1 -12 o a mobile home that Is
$
not assessed as Bat property or to a manufaWred hone that is not assessed as real property may not exceed
,
one -half (12) of the assessed value of the mobile home or manufactured hone.
Signatura of Auditor 717777
day, year)
y