Homestead_Johnson (4) CLAIM FOR HOMESTEAD PROPERTY TAX EAR
;f__. STANDARD /SUPPLEMENTAL DEDUCTION H""? ';
- State Form 5473(R13 1 12-09)
.N ,e z Prescribed by the Department of Local Government Finance JAN 1 2014
INSTRUCTIONS:See reverse side for filing instructions.
;, _,:/.2 / `CERTIFICATION STATEMENT _ nt7,
I(We) _41War i J2 /- certify 13ibt: %-1011. .. ' NItil1al
place of residence or am )buying theowing described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
un er contract on the da'is application s filed, (date of filing). I(We):
n ❑ 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.
•_.. "c, ' .,e„f 4yi _�T'liiE'a:-=..` ..F -;.. -.- CLAIMANTyS:INF_ORMATION.'.-. - '.�....-t. �_�._- �._ - . ...�"�. es�sr -:_
S CONTRACT RECORDED' -
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
1
_ :TRROPERTY DESCRII/TIOtd _ _ _ - - - `-_t•
Court 0 u Township Taxi •district(city,town,bwnship) / •
Parcel number Legal description •
L e Is the property in qua •
p35/,3 �!/C�-' I Ji Real grope Annually assessed mobile home(IC 61.1-7)
If any portion of a residential structure or the land not exceeding one(1)acre that immediately surroun s at structure is us top uce income,describe the use and portion
of the property utilized to produce income.
id - 6G i9--/66 - oao. ti a-o/'7
- .._...�_ ._ .. ._. . . . .
- _. - - - PROPERTY OWNED B -.
Y.CLAINANT!MOTHER COUNTIES,- •- _, "7
County Township County Township. A
e of I hereby certify the above statements are true,correct and complete. Signaturnt
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Address(number and street,city,state,and ZIP code)
3ON Ffawe5e 7 '
I ASSESSED VALUE - HOMESTEAD - NON-RESIDENTIAL
ASSESSOR USE ONLY'. ' TRUE TAX VALUE o <
_ . _, _ . ._�a ....fly ATc100%OF-TN -- .VALUE-- 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) `
Accessed 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.
Verifying action-Signature of Auditor Date signed(month,day,year)
__ _ _.. _____ .A. . -. - _
' D.DE STANDAR - DUCTION 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 properly may not exceed
one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)