Homestead_Dillon (3) z CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION • FORM
6 State Form 5173(R13/12-09) HC10„ Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. 81 11"7 '2 /- 2 o 5 O _
CERTIFICATION STATEMENT
I(We) � /L f .- M, �_ certify�tha ` we .. •• • JP}my(ohycJrindpal
place of residence or am(are)buying the following .'scribed real property 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): NOV 2 0 2013
® Own ❑ 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 pi wige• AUDITOR
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
- __ . . _?,.•,.
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
.1
•i --' *EROP,ERTYMESCRIPTION - _
County Township Taxin••i tric town,township)
' 7 -
Parcel number Legal description q ,/� Is the property in question: I
f..i o /,�-ry R /74 ❑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)a that immediately surrounds that structure is used to produce income,desaibe the use and portion
of the property utilized to produce income.
cot CO -0 '1- dq - 3o41 - 000. oacj,-oao• _ ._ _
. _ - - - . PROPERTYOWNED BY CLAIMANT IN OTHER COUNTIES - .,:z • -
County Township County Township u
I hereby certify the above statements are true,correct and complete. y Signature of claimant � `
Address(number and street,city,state,and ZIP code) / ,h��f I ��,/
X bola -I- i t - £ q Cob 6
ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
ASSESSOR USE ONLY _ ITRUE TAX VALUE.!•_AT-100%OFTN .I -_ .VALUE I - VALUE -
Land not exceeding 1(one)acre immediately
surrounding residential Improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3) I
Dwelling (4) i
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)
hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
I and complete.
Vaifying 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 61.1-12 to a mobile home that is $ ,
not assessed as real properly or to a manufactured home that is not assessed as reel property may not exceed
one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signat re of c I Date signed(month,day,fear)
lTT Tint