HomeMy WebLinkAboutHomestead_Hedges SCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD I SUPPLEMENTAL DEDUCTION HCtp
tate Form 5473(R13/12-09)Prescribed by the Department of Local Government Finance
INSTRUCTIONS:Se:reverse side for filing i.structions. 11711/ 11- 1-1 -aa
1 CERTIFIC•TION
I(We) f, _
jj sk■I -IL,/ a I•
'��� 1 .�_ �� certify that I(we)occupied as my(our)principal
place of residence or am(are) — g the followin.(.escribed real property for which a Homestead Property Tafl$t9nd2rd D dy tion is hereby claimed
under contract on the date this .Iication is filed, (date of filing). I(We): 0 LL UU 33
Own ❑ Am(are)buying under recorded contract )/n/4.
Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation IIrC' hHrt' {
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a q of iea persar aa1- 14r/aUMJWttOR
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
I ' _ (EMIZEDO INFORMATION r _
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
u — — — PROPERTY DESCRIPTION .
Cou Township Taring tlistrid township) I
P3cel
n(uI(-er Legal description I Is Lypp in question: I
'l uT117 '. eal properly
❑ Annually assessed mobile home(IC 61.1-7)
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.
.
PROPERTY-OWNED coiMmuo OTHER COUNTIES
County Township County I Township -t
g `
nature of claimant
�
ftereby certify the above statements are true,correct and complete. _// _r (
Address(number and street,city,state,and ZIP code) / • I
ASSESSOR 1! 1 ��ASSESSED•VAgT E J HOME. ST EAD I o NON-RES T DENTIAL
Land not exceeding 1 (one)acre immediately 1
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3) I
I
Residential improvements or Annually Dwelling (4)
Assessed Mobile/Manufactured Home Garage (5) I
Other improvements (6) t
Total improvements(line 4 through line 6) (7) I
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 I Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 1
Notwithstanding any other provision,the sum of the deductions pmvided in/C 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(1R)of the asse ed value of the mobile home or anufactured home.
Signature of Auditor r A th,day,year)
1//y._ OCT S 2013