Homestead_Wright (26) Z CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
4 STANDARD /SUPPLEMENTAL DEDUCTION
sState Form 5473(R13/12-09) HC10
,e Prescribed by the Department of Local Government Finance
INSTRUCTIONS:S:;reverse side for filing instructions. ,,_ •
- - - _ _ CERTIFICATION,STATEMENT-_ ' • - - _ • ' - -
I(We) -V I/j�V.��YS1I��j'd r t certify that I( o�pie• as my(our)principal
place of residence or a -)buying the f• 'wing described real property for which a Homestead Property Tax-StppddrQDprcyrstion is hereby claimed
under contract on the • is application i ed, (date of tiling). I(We): r ACS 1 Il L 14
❑ Own ❑ Am(are)buying under recorded contract /),
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation 7/f/l
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a guSl QnsCaLiti cMr1A8)014fOR
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
'-•_' it az? 'Nrti+-t'4 ':•..-- CL'AIMAN-ris.INFORMATION ; '7' 7 t_edAli ',4
.''_ —`?:".-_--
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
'st-. - - a,. i r e _ z.r* . t= „P,ROPRTYDETC R_IPTIOa-;=7
'_ . 1.11 ' ._ , w - -
t Township Taxing disti t ownship)
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• \ if AO;
I number/-� 00 Lq!al de � tion - I Is the property in question'
1 a--lJ��l O�"`^��O T•O•-'�,) rRfT(7,y(f eal property ❑ Annually assessed mobile home(/C 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrou s that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
__ --, _ r ,,,, - , -PROyERTYOWNEDBY_CLAIMANT IN OTHER COUNTIES -,, -,�.__ _,.-_ _ ,L?
County -?Township County I Township
I hereby certify the above statements are true,correct and complete. Signa(�re of claimant` ���
' (.
dress(nrber and street,dry,state,and ZIP code) � ^� � O
IP t &X / _ TOWN i Al / _
'°- "”'� '='• ASSESED-VALUE --HOMESTEAD NON-RESIDENT---I r. .
ASSESSOR.USE ONLY -• s •TRUE TAx7VALUE
- .-- --- aa;.ais.mg•s.t-ins -s.1-1 z,4,- -•.a. il,t1_ ATSI00%,0E4TiTVrtl-.- ,VALUED cl - _. VALUE
Land not exceeding t(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line I plus line 2) (3)
Dwelling (4)
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) (5)
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)
' „1 d,is. -:::STANDARDDEDUCTION ALLOWANCE:1-1" _
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-t 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-hall(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)