Homestead_Farmer (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' u'i. STANDARD/SUPPLEMENTAL DEDUCTION FORM
HC10
•1 State Form 5473(R13/12-09)
; T Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. i r
. - E yERTI 74;�NSTEMEN aisZsg € at T tf:L .r
I(We) Ain nnine _, certify that I(we) ..:r pi_. as my(our)principal
place of T I-nee or am(are)buying the following described real property for which a Homestead Property Tax Standard Deductiigr)i hcr�y,gajpred
gun der..041T on the date this application is filed, (date of filing). I(We): MA LU I4
(� Own ❑ Mn(are)buying under recorded contract 4 -el
!❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation I. , cgirMO•
p Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal rettlEISONsCOUNTY AUDIT'0 R
❑ Am(are)the shareholder, partner or member of the entity that owns the property.
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+�::ic: '�_.._a.�' ',i,2"�►:r:.N�,�'.��� S.'.� ��Y"aLii::Flw ��a.ni�a'..` J -
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If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
ins ? is l:;; TS ,.Ldc W `. s PROPERT,Y..DESRP.TION s» i 111T . f,ai-Wt `t" .Fi a.'. +s
Coun• / c, Township Taxing • •-.• city,to ,township)
40 / a9C) ci y
Parse number Legal desolation Is the M in clues'
al 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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
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��' ''�- fir ay.:�"'y�'�-.p� t��, `�','�PROPER;YiOWNEDJBACLAIMANT'IN OTHER�COUNTIESy,;,_p ,.` a Ltia(
County Township County Township
I hereby certify the above statements are true,correct and complete. signatu of claimant
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Address(number and street,city,state,and ZIP code)
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s'4 rK z;:iy]'c? I ktE.f arty~ r`" ` -Jam'-r=1> 1ASSESSED VALUE NOMESTEADYt.j7-3 , W6N- RESIDENTIAL'J-1-+,yt
8 4 ' 'YASSESSORl USE.ONLYR t7- "+ t.�,TRUEtTAX>,VALUE' r a Ke vAL'UE t t h
SC t ar`;v2,--,w wcunsaIcwai;r�:� °a,'` .a.:3 _- _ ikATL100./�OFgTrT,V,1 p'LVNAlEk7'+ i s
Land not exceeding 1 (one)acre immediately "T.--- ' -1 r - - S
surrounding residential Improvements. �" '£. `
Other land (2) [/
to Total land(line 1 plus litre 2) (3) :9,414 _ G" el /. it
r?•Dwelling (4) ..1- -
r. . .'
Residential Improvements or Annually n -
Assessed Mobile I Manufactured Home Garage (5) 0-c' /t"/ /
Other Improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
Signature of Assessor Date signed(month,day,year)
I hereby certify the above is true,correct,
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
: r- '3 S '"E-.'" STANDARD)DEDUCTION+AL OWANCE- -' -�.r tictin aA517 -r t e S
?a��rtis".�s_ ��4" SX;Y? +�.n�4� ... . _...-�. . .W.._. �hos� �...s�w T.,S`�S�S`.-1 -.t' '2�.`.:vd..r_.
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 toe manufactured home that is not assessed as real property may not exceed
one-half(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor . Date signed(month,day,year)