Homestead_France (2) °'"� CLAIM FOR HOMESTEAD PROPERTY TAX T!H ]r S1�
-e__ STANDARD/SUPPLEMENTAL DEDUCTION jT '�'-`,
0.�' ,/'� State Form 5173(R13b/12-09)
S Prescribed by the Department of Local Government Finance
SEP 3 0 2013
INSTRUCTIONS:See reverse side for filing instructions.
CERTIFICATION STATEMENT .
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(We) I - �_ �,�` J = certtfY8 •) f WUUI )1MeciPal
place of residence or am(ar-)buying the following :-.cribed real pro.-rty 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):
n ❑ 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
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
i. _ _ _ ;
_ . 'm;"�'- -,L..`. . <--2" _ .. CLAIMANT S]INFORMATION'._ --
, ._- _ .
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
.I
. . . _ _ PROPERTY DESCRIPTION .t_
County Township T 'ng • trill(city,town,township)
Parcel number Legal description Is the property in question:
acs• t8 .35- I bp-( • 53(n— co.44 • 1 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 surround hat structure is used to produce income,describe the use and portion
of the property utilized to produce income.
- _' - ,PROPERTIYFOWNED,BY CLAIMANT IN OTHER:COUNTIES - , ,
County Township County Township ..
S
I hereby certify the above statements are true,correct and complete.
tore aimary-. - `
s
Address(number and street,crly,state,and ZIP e)
'' j . 7 S. Clan o , Or. grub ad . i 't7G3'
CC. ASSESSOR USE_ONLY • I.TRUE TAX VALUE PI ASSESS EDV_ALUEI -_-HOVALUEAD I e NON- ESIOENTIAL
Land not exceeding 1 (one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Annually Dwelling (4)
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)
hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
I and complete. •
Veifying 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 ditor lb.�l_.r_� Date signed(month,day,year)
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