Homestead_Gee 4 R�a CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
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= CREDIT/STANDARD DEDUCTION HC1O
'y State Form 5473(R5/10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
tPr4t t ri - `. ?->_:- ."CERTIFICATION STATEMENT-2, . . - _ ••
I(We) �gE-r_ 79 0% 6 P KA-c. certify that on the 1st day of March,20
I(We)occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I(We)owned ❑ Are buying under contract
I lave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
t•a-Tx s S� mac' - _' �G N� _ . J .. �^� • i :.., . :OH' .
r;=.a _-� _.,,v`'� _" x..ht :i..z.t*it 'CONTRACT�RECORDED �, it.X:;Srea+ 'S +
If buying on contract,Fee Simple owners name
MAR 2 R 2002
Recorders office where contract is recorded Record number / Page I ry/
•*W f'-`' „,to . .. .:3= 4 tay.2-rn4-sg,..:.PROPERT(.DESCRIPTION; ' x. e: (:r tYiz.."bI OUti . +U'\T'� frii.:
,r� Tavns g' Taxing distric t town,I nship) .1
P fceI number L e g a l description Is the property question:
S -r QU( "—p0 - 6904 Pig / /-,3 ❑ Real property Mobile Homo(I.C.6-1.1-7)
If any portion of the residential structure or the land no /ex ing 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. CC//
w- ..,4,
411r \itAiVirea4W 141:: „r::%•f t s;z :lrPR0REMY.OWNED BY CLAIMANT IN OTHER'COUNTIES>„- :14.: '.ti': ',., ..r.= -`. 1fj:'-'
County Township County Township
I hereby certify the above statements are true,correct and complete. Si atur f claimant //
ire ( mb and street,city,state,ZIP code) ��� /C/'/9�'•
LPZ.43 2? ?99 -3 7 i/Yo{on, Ind.. VX X
'� `'rsASSESSOR USE ON Y ESL�..S- _fsTRUE TAx� ASSESSED VALUE HOMESTEAD E ti ANON RESIDENTIAL rE
:a-.ra4w 'i".WA'�' '3...., <S.c =:-4,7 : a .VALUE_. _AT.100%OFrTT/..isga:VALUE y - + 1 41-g VALUE ..t aa.?",:
Land not exceeding 1 (one)acre immediately `_s.11r- I‘I. it. "7 j y
surrounding residential improvements. (1) =I�',.,..,!4..`,-y4_S, r-#",
ac+ t
Other land (2) ' g=;� 4'S`3?;.
Trial land(line 1 plus line 2) (3) /-3// 1 /( t A /el a)( „..
Dwelling (4) tTe. '+', t v x 1. ,-4r ,..
Residential improvements '” &' �L'°Y''' �, ,,,V.E '
A r M T^nF ; 1a ~
Garage (5) / Z // eo' % 9211 /Q47 /P/1/43E/o /
Other improvements (6) ,_s £
Total improvements(line 4 through line 6) (7)
Trial value (line 3 plus line 7) (g)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
_-maT. am - 4-C=...i�P3Fr irliga i. .-STANDARO.DEDUCTION ALLOWANCE i :•.'.4.a.� 1 L Va -_".y �. . n. ...
20 Pay 20
(fr Lesser of.1/2 omest ad
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Signature of Auditor i DaI4signed