Homestead_Schu "'"a CLAIM FOR HOMESTEAD PROPERTY TAX aa-,r
:a STANDARD /SUPPLEMENTAL DEDUCTION H f_�
State Form 5473(R13/12-®)S , 4" Prescribed by the Department of Local Government Finance Ili
INSTRUCTIONS:See reverse side for Ming instructions. DEC 4 2013
„_ ' CERTIFICATION STATEMENT _(We) I C l I c , IFi'Tfr ° p
I e .�i. ��../I_ certify thatl(kveeppgg .-(f��f�1'1d*�4il 1prind al
place of residence or am buyin f e followin✓•escribed real property for which a Homestead Property Tax StanciMe9-•ucatiN •A/411 W
under contract on the date this application is filed, (date of filing). I(We):
❑ 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 personal residence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
'tom'. F. t.: ___ _. YIIl� ....�
-"' -:i_ 'il}y,.- ;, _ ,� s.'.,CL'AIMANTaS INF_ORMATION`_: LL-,r-n .�.. _ . .- ya._:.�.f =•'• t_*
_. . CONTRACT RECORDED' -`-
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number I Page
.1
' ; - - • - PROPERTY DESCRIPTION .4
Conn F _N ' Township Taxin di 'ct(city town,to ) II!�/f
Parcel number v� L scriptio1 Is the p perty in questi dh: F
�" ) �z d/J/—/0 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 surro dint structure is used to produce income,describe the use and portion
of the property utilized to produce income.
a-X90/'—jao-090.9- o4r-
r z4_. - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County I Township County I Township ,
Signature of claimant {
I hereby certify the above statements are true,correct and complete. X17./, �' A
••dress(number and street,city,state,and ZIP code)
7747 a S -200 L' ft. B�c...c 6 Z.,z/ y 7G YO
ASSESS VE a ; E I O D1 NON- NTIAL- -•ORUSEONLY r AA
_ ATr00/ OF TTY :HVALUE • VALUE
Land not exceeding 1 (one)acre immediately
surrounding residential improvements. (1)
Other land (2) I
Total land(line 1 plus line 2) - (3) I
Residential improvements or Annually
Dwelling (4) I `
Assessed Mobile I Manufactured Home
Garage (5)
Other improvements (6) I
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 I Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor I Date signed(month,day,year)
.-
• STANDARDDEDUCTION 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.
Signature of Auditor I Date signed(month,day,year)
I