Homestead_Bathgate •
I
zi. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
1_ STANDARD /SUPPLEMENTAL DEDUCTION FORM
sState Form 5473(R13/12-09) o HC10
,� Prescribed by the Department of Local Government Finance 0 /2.16 4,(,f_3
75 o 't
INSTRUCTIONS:See reverse side for filing instructions. Al tll — J
. - CERTIFICATION STATEMENT ,
I(We) t` irlJiff/ ' Sr t I certify that I lid; ( 'papal
place of residence or am(are)buyin,/ e following describ real property for which a Homestead Property Tax S lorrigs Aer'1 :imed
under contract on the date this application is filed, (date of filing). I(We): gJ -
❑ Own ❑ Am(are)buying under recorded contract NOV 12 2013
❑ 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 re )ence tr st
❑ Am (are)the shareholder, partner or member of the entity that owns the property. Il
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... .. - _
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
I
- .:-PROPERTY,DESCRIPTION - ..
County Township. Taxi ,fr:P bid(city,town,township)
Parcel number Legal description c Is the property in question:
Oeaa a Pr ❑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.
A6)-/3-.07 a 403 -000 . 117. -o ?-8
-{ � . . _
' -. - - .PROPERTY OWNEDABY CLAIMANT IN OTNER,COUNTIES_ - -- _ -
County - Township County Township 4
I hereby certify the above statements are true,correct and complete.
Signature of claimant .
e x
4" Address(number and street,city,state,and ZIP code) d
(oo/ s S ' ,re,L, .n- 97670
ASSESSOR-USE ONLY _. -I TRUE TAX VALUED AT-100%OF_.TTV. I -HOMELSU'HOMESTEAD- I e NON-RESIDENTIAL
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
Accncced 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)
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- - 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(1/2)of the assessed value of the mobile home or manufactured home. .
Sign ure of Auditor Date signed(month,day,year)
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