Homestead_Fithian (4) °''a CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
s-_.. STANDARD / SUPPLEMENTAL DEDUCTION HC10
State Fond 5473(R13/12-09)
S ,e?' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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ez\_ ` • Al n ri n ' CERTIFICATION STATEMENT _ -
I(We) `./_ . !! . !&[l .'k.A - certify hat I( = .• r..-••as.my(our)-• opal
place of residence or am(aril ying the ¶.wing described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this .pplication is filed, (date of filing). I(We): NOV 2 0 2013
❑ Own ❑ Am(are)buying under recorded contract
p 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 perso6HB1jd TY AUDITOR
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
.-. . MANTS I'NFORMATION:-u,ri z -a t,-1,..-7-=,7a_ - y.5.'; t.-.:-
._ 3
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If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
n - . _ - `- _- - <;- PROPERTY DESCRIPTION., t- T r. 71''/ -/yr--__� . .
_`�� .- Township Tarring district(city,town,t m ip) I+
i.e
IP�arcel number / /�Legal description Is the tprroperty in question:
a44 q--c21 � /7��j • l yl Beal 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.
, ;.._ = PROPERT`F,OWNED,BY CLAIMANT INbTHERQOUNT(ES __ _ _ _if
County Township County I Township
I hereby certify the above statements are true,correct and complete. S'.naturree of claimant 1
Address(number and street,city,state,and ZIP code) l , 7.4...e I' I v"`/-�"
750 3Po �� �� iv,c9 7G 7
iY �- ASSESSED VALUE - HOMESTEAD: NON-RESIDENTIAL
ASSESSOR USE ONLY _«I TRUE TA VALUE I -
.a-� AT100%-0ETTV _.-VALUE.t _. s_ _VALUE. '°"
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 phs 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)
_ 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-ha (1 of the assessed value f the mobile home or manufactured home.
Sgnatur Of ditor Date signed(month,day, ar)