Homestead_Rich CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4— `__ STANDARD / SUPPLEMENTAL DEDUCTION FORM
State Fonn 5473(R13/12-09)
Prescribed by the Department of Local Government Finance
r
INSTRUCTIONS:See reverse side for filing instructions. ) ,
I
. - • - ° CERTIFICAVON STATEMENT - •I(We) //ice, Ws_....Mr _., 1.1. r____._, certify that I(we)occupied as my(our principal
place of residence or am(are)buying the following describe, real property for which a Homestead Property Tax StandaB(,*dlc832ib Jlpreby claimed
under contract on the date this application is filed, (date of filing). I(We): /� CC 1111�l,.jj
❑ Own ❑ Am(are)buying under recorded contract �//[. n ,�_
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation GIB NOIP�tt[_I���3YT�+v+:'N9.Q�
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal reside
«(isE�UDITOR
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
.-- - .,e_' r :: .v artflt. ^4 _4-.t4- C-LAIMIiNT;S.INFORMATION,` '' 7 ‘:a ik: i-.. .4.0 i
- _ _ .. _it-
„., IP:. CONTRACT RECORDEDTs� -_17: ,In--�i ".3 ,._ ,, _:_rd`'- _
If buying on contract Fee Simple owners name
Recorders office where contract is recorded Record number Page
-
--
County Township Taxing i 'd(dry,town,township) ,� �^
Parcel number Legal description I Is the property in question: 7
Pdr_SE 3`+ -3 -i/ a. tin-IAC_ ❑Real property ❑ Annually assessed mobile home(IC 61.1-7)
If any portion of the residential structure or the land not exceeding one(1)aae that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
AIv-ls7- 3 `l- goo -ood . ?9Y-Drily
;;,t,- , ,�v,, '„ ,�; PRPERT�OWNED;BY C LAk MNTINO TER.COU_N TIES r ' , ;° ax; „ :I:,.. ...tF
County Township County Township
I hereby certify the above statements are true,correct and complete. yS:`l�" f iman /C 32 QZ$-7
Address(number and street,city,state,and ZI code) '` /
o 2 s'/ 5. CL a5o £ ) I Inn •' Y7co Y67
' '-'�' '� :71'rASSESED VALUE"y_HOMESTEAD ^ .''r NONiRESIDENTIAL`
ASSESSOR USE ONLY - TRUE TAX VALUE
;-.. !�., _ .� . -.0 ae�..:±.-2 - cai,nAT•100%,OF TTVb..,. a;?'VALUE r d - _ • VALUE ra
Land not exceeding 1 (one)acre immediately (1)
surrounding residential improvements.
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.
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 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 Auditor Date signed(month,day,year)
