Homestead_Hendricks •
{:•,e, CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
/ .� STANDARD/SUPPLEMENTAL DEDUCTInki Hc�o
:,e, u State Form 5473(R13/12-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. 11..1 re.
.w4tt,V*; .. Ste.sr-vI;;7 A+I i11_` k'°.Irkizit CERTIFICATION'ST�ATEMENTni{f:�uti2 a}.b .v n-X t.'Sf-: +n 1 'r;'-=
I(We) 'Se l �l� / /�/ ��i__ e - ex certify that I(we ocalpi. as my our)pnttdpal
place of residence or am(are)buying the following described f al property for which a Homestead Property Tax Standard ggduatiqt {i hprfeJyy claimed
vier contract on the date this application is filed, (date of filing). I(We): U 1. L G LU)L
Own ❑ Am(are)buying under recorded contract C. .
❑ 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 person$6(g$eW1311tjgtTY AUthTOR
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
.'7Utx-.'.`s ,-'s:".iiak4 :1193 ,Z)qi.<.&i.kat..ad ?.'JCL-AIMANT,SIN ,ORMATION7-elaialt.;N_ .ilik ",.". r'T.r': `?., k-tf-t:.;-.„tC:::k?7)
::,
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
A,3.):3Winl t r.aF.i'.t iali+?1-;53ii.A. .i,P,F20P.ERTY:DESCRIP,TION n&iia V::1 ..13414 .1. ..',ftt.i • 6+ as Sx_ ,.�•'�;
raja Township 1111W ' eV I 1
Parcel number Legal description / Is the property In ques'
01•002 //// ❑Real property Annually assessed mobile home(IC 6-f.1-7)
If any portion of the residential structure or the land not exceeding on- ,,,, -cre that Immediately surrounds that structure a u o produce income,describe the use and portion
of the property`uti�ed to produce Income.
4 d. 1Y P43;; y_ k Y ,1 -...e_
F.'a'4'.rltw+_r� 4..r.`.�L... .]<.fl`,R�. .... ..i^�:PROP,ERTY�OWNEDBYCUAIMAt,T�IN OTHER"�COUNTIES,swht!raAta�.," ?'t t,?.'.,�itr,_`_ ..Y. Z4:
r County Township
ii.«I/a 40 . • of
I hereby certify the above statements are true,correct and complete. e
a.+.z - r,`< `'t�z• a 'fir+ a r. a. ., F'ASSESSED V AGUE HOMESTEAD:c ;:NON RESIDENTIAL - ,:"
1
i., t _`..�.Yi-ASSESSOR USE ONLY T;y..N t ref TRUE TAX VALUE I, AT;100 o OF?TTV.tta ,a'.VALUE>f ww " ?:r-s �;iit,g'VALUE c -/i4—' 1,
Land not exceeding 1 (one)acre Immediately r'ri-.-r '+ - y i•S"
surrounding residential Improvements. (1) j ..+ 's...'. :,*.-:s .")..`.'". -' '
�}� x',,,,v1.
Other land (2) v.z/rT. ,T7.
Total land(line 1 plus line 2) (3)
V c - a '-sec,-1
Dwelling (4) p,� . K r ie
t.Residential Improvements or Annually
Assessed Mobile I Manufactured Home » r s'?i 4. ,§Gara e (5) a rate ,S ,FS s 'a : t,
1'rc� ; °lsy
Other Improvements (6) ha£ 3} 3x•
:.
Total improvements(line 4 through line 6) _ (7)
Total value (line 3 plus line 7) (6)
I hereby certify the above Is true,correct, Signature of Assessor Data signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
`' f- `1�' Z`>>' ^ �'fr ig .`� ANDARD UEDUCTION,ALLOWANC E+ S„ 1;(a " r u ;y;ti",:lin..1, tAt?'
d.s,-f..,_t.ze:.S:��..t: r...e.�..�.«i4YZ+e-,...?"-!• T_ _ -_ _ ..... , ., 1kt. ;t_ti...r�
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 toe manufactured home that is not assessed as real property may not exceed
one-hat(1/2)of the assessed value of the moble home or manufactured home. F
Signature of Auditor Date signed(month,day,year)