Homestead_Moit (2) "'n CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
°� - '1 STANDARD / SUPPLEMENTAL DEDUCTION FORM
State Form 5173(R13/12-09) i 'C r
.� ,��� Prescribed by the Department of Local Government Finance — t
d ,
INSTRUCTIONS:See reverse side for filing instructions.
!', - ,. --s _ CERTIFICATION STATEMENT_ -
I(We) W .�5-'w��__�\. certify that I(we)occupied as my(our)principal
place of residen.- or am(a -)buying the following descted real property for which a Homestead Property Tax GIBBON Standa/a/Deduct' n Y i aimed
under contract on the date this application is filed, (date of filing). I(We):
COUNT AUDITOR
LAPewn ❑ 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.
LE:Z.F:�� %' '_ CLAIMANTiS_INFORMATION `- '- .
$ tn.- -= e.
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number I Page
= - -.PIiOBERTYDESCRIPTION + -- 'fr. ra 'v " •Cri:
County Township Taxing distri . .town,township)
Parcel number Legal description Is the prop in question.
Ar� ''t �1 q 1 �
L -' L— .S d`D� t ¶—e 1 - _. Pteal property ❑ Annually assessed mobile home(/C6-1.1-7)
If any portion of the residential structure or the tan tanct 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.
.�-, jg_PROPERTY-..OWNED:13 CLAIMANT.INOTHERy000NTIE35 7 ,,,-_zit;TYt•, e_ _!'__."..2
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature/claimant if
Or Q hh—
Address(number and street,city state,and ZIP code) '
/ . .
ASSESSOR USE ONLY •' .:I TRUE TAX:V -ASSESSEDVALUE I -..;,HOESTEAD NON RESIDENTIAL` =°
sv _ _ w �_. d cur-s--s aaa aaATe100%,OF4TilVa..uit:•"-',VALUE _ ;' VALUE _ - .1
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/Manufactured Home Garage (5)
Other improvements (6)
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 Date signed(month,day.year)
and complete.
Venfying action-Signature of Auditor Date signed(month,day,year)
'.::." ...rra:� ..47 -TZ;s �. ,�-....r ..-s?STAND_ARD,DEDUCTION,ALLOWANCE 7.7. ,. 77- . - a..:. _ 1,2..- _-
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 properly 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,�y ar)
- .1—aD -'4`t'