Homestead_Andrews CLAIM FOR HOMESTEAD PROPERTY TAX YEAR -
__n STANDARD /SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R13/12-09) HC10
' ,�,� r Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
• CERTIFICATION STATEMENT ' -
I(We) J.. 0C N• re (n5 certify w o pied as m our)principal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax d fledu s '\\ claimed
under contract on the date this application is filed, (date of filing). I(We): I I
M Own ❑ Am(are)buying under recorded contract
Am (are) entitled to occupy as atenant-stockholder of a cooperative housing corporation JUN 12 2013
❑ 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. I
,
—
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
,,, - : . - ,:P,ROPERTIDESCRIPTION
County .1 t - Township Taxing district(city,town,township)
Mont•
Parcel number Legal description Is the property in question:
t P * SE r!li) 6- 3 -)a DrReal 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 stature is used to produce income,describe the use and portion
of the property utilized to produce income.
a6- 1-1 - ► 10 - 100- 0011 . 8' 1 '7 - oa )
- . �
- - .PROPERTI'�OWNED BY-CLAIMANT IN OTHER COUNTIES,. ; _ _ 7 ` _.,; ';
County Township County Township .
I hereby certify the above statements are true,correct and,complete. Signs ire of dai . t
Address number and street,city,state,and ZIP code)
0 400 S c-5 .0 4 r di I to e✓rs' 6. A
ASSESSOR USE ONLY. - i . I TRUE TAX VALUE d AT.:100%OF TTVE HOMES VALUE AD I _< NON-ESIDENTIAL
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 I Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits 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(1/2)of the assessed value of the mobile home or manufactured home.
Signature of ..\.5 ' ..�/ - Date gned(month,day,year) -