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Homestead_Fuhs \� . CLAIM FOR HOMESTEAD PROPERTY TAX i e - E • r4':a ,, STANDARD/SUPPLEMENTAL DEDUCTION ' 1� y�y:.. State Form 5473(R12/6-09) ' ,,;-' Prescribed by the Department of Local Government Finance • DEC 18 2012 INSTRUCTIONS:See reverse side for filing instructions. • C, . • - t ® CERTIFICATION STATEMENT n1� na. I(We) /_'l f! a liTr certify G 4Qt!j istnq�Jr9Andpal place of residence or am(are)buying)a following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed 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 daps (legal na ) • • ) Name of da ms's sspp/otCs.se^.�laga name) If buying on contrail,Fee Simple owner's name • . Recorder's office where contract is recorded Record number Page . PROPERTY DESCRIPTION Coin• Township Taxing d' Li (city,town,townshi• P. .-n mber ey9��e�pan Is th- property in question: 7 fY`/tif /-3-/0 A Real properly ❑Annually assessed mobile home(IC 61.1-7) ® Ufa/illy portion of the residential structure or the land not exceeding one(1)acre that Immediately sumo:nds that structure Is used to produce income,describe the use and portion e prepeny utilized e poduce Income. �Immediately 7vo -002 3 - oar • • PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Township County Township • I hereby certify the above statements are true,correct and complete. Signature of claimant fi-Lxi.A9M(Y- Address(number and street,dry,state,and ZIP code) © — F-cLnCA-a f5 te CE -CA.Ll9 ASSESSOR USE ONLY I TRUE TAX VALUE I AT E00%OF TTV I HOMESTEAD AD ( NON- VALUENTIAL -i'.-•-Par..r.•� Land not exceeding 1(one)acre tints. atety Sys^. ,}, ,x. "-�" ;•sn surrounding residential improvements. (1) ': ;£:#_ -4'"z,-..-= ,. t t Other land (2) o" t it-3".. t - Total land(line 1 plus line 2) (3) 55 a ^'] r b' : Residential Improvements or Annually Dwelling (4) :',WI ; r 'r '-°d Accnesed Mobile I Manufactured Home S ne D `+(3-Y.%Garage (5) ti „. nwY3• Other Improvements • (6) .4.3+ its eft.. Total Improvements(line 4 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. Ver hying 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 aysnssed as real property or to a manufactured home that Is not assessed as mat 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)