Homestead_Byers , 1 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
j..:1:4::-..,, STANDARD/ SUPPLEMENTAL DEDUCTION •
g ' 1 State Form 5473(R12/609) HC10
\ ,r. Prescribed by the Department of Local Government Finance
INS TRUCI7ONS:See reverse side for Ming instruction. • 13 / I '
•
® CERTIFICATION STATEMENT
I(We) ns._J _ _a• L L...-.A_ - certify that 1(we)occupied as my(our)principal
place of residen.-tram(are • 'rig the following described real property for wh'. a Horn-stead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
I(We)own p Mn(are)buying under recorded contract
Are (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
N of dart(legal name)
It A ) O •(4 t
N of,da' 's spouse(legal name)
CONTRACT RECORDED
If buying on canted,Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township T' - • •itrict(city./own, •wnship)
`Mt a.
.•
Parcel number Legal description 1 Is the property in question:
a &- a. a -v-0 3- a o• -oa a -5 a'l-o a L I property 0 Annually assessed mobile home(IC 61.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sunou that structure is used ID produce income,describe the use and portion
®
of the property ribbed to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true,correct and complete. S'• u .'of claimant ^
Address(number and street,dry,state,and ZIP code)
♦ aliti
I A
ASSESSOR USE ONLY I TRUE TAX VALUE AT 100 E OF TTVE I HOMESTEAD NON-R
VALUE 7E�SI NTIAL
UE
Land not exceeding 1 (one)acre Immediately (1) . yia ' ti :•- K
surrounding residential improvements. O -Yw' 3 .Cif
Other land (2) k. a>kIl
Total land(line 1 plus line 2) (3)
Residential Improvements or Annually Dwelling (4) :No `. y'I" py.
Accn,ed Mobile I Manufactured Home w' 4"� i ;" k 5
Garage (5) .3 ' F .>w
.ww
Other improvements (6) ? Vii.
Total Improvements(line 0 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete. •
Verifying action-Signature of Auditor Date signed(month,day,year)
® 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 6-1.1-12 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(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year) •
�rt ` Li It,— aq -1,2