Homestead_Dye CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
FORM
4-._ - 1 STANDARD / SUPPLEMENTAL DEDUCTION
�'• State Form 5473(R13112-09)
‘ ,,,, Y Prescribed by the Department of Local Government Finance - —
INSTRUCTIONS:See reverse side for fling instructions. !.;
• o. —_,n n . CERTIFICATION STATEMENT wry• ` ` -
I(We) %! AL•y�_A, . jag I property ,laq t'i at lAys occupied as my(our)principal
• place of residence .�am(are)buying the following '(cubed real for which a Homestead Pro ltdn�l d Deduction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We):
El Own ❑ Am(are)buying under recorded contract L _
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporati®1RSON COUNTY AUDITOR
p 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. .�+!
-'-/, a ,r-e�:_: - r..t ` girfa_L'AIMANTSINFORMATION �. a Z1 i•_. _ ,.5.=.,fix:.
- _ . _ II .7-1 a -ZCONTRACTlRECORDED, i . •':- 2C---, -- _-:a _
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
m1 PROPERTY DESCRIPTION _LL , : . 3. t -._ -rt
County Township Taxing district(city,town,township)
arcel number Legal description Is thh�,-,7property in question:
A-1313 -ko4-000 213 cob I Real 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 structure is used to produce income,describe the use and portion
of the property utilized to produce income.
!_• i t,.; i. PROPERTY OWNED:BYCL`AIMANT N OTHER,COUNTIE¢ ;. ., - -"- ..
County Township County Township ...
I hereby certify the above statements are true,correct and complete. Signature of claimant
Address(number and street,dry,state,and ZIP code)
ASSESSOR USE ONLY - t r`TRUE TAX VALUE ASSESSED VALUE HOMESTEAD NON=RESIDENTL4L° v''
.t±..-.I A�r. ,+._I+AT.10O%OF..T.TVra .•:VALUE+ . ' _VALUE _..'.
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 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)
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 _
Notwithstanding any other pmvis/on,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 kiditor • . Date signed(month,day,yea