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CLAIM FOR HOMESTEAD PROPERTY TAX
_rt STANDARD / SUPPLEMENTAL DEDUCTION
s State Form 5473 (1112/6U9)
Prescribed by the Department of Loral Govemment France
INSTRUCTIONS: See reverse side for filing insfrudws.
FORM YEAR
C A
NUV 2 9 LULU
CERTIFICATION STATEMENT
I (We) 22=4 le 42
certify that I jwefxiiiaupie',i sy (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property �� S�(tayndard 66ductiort is hereby claimed
Gm %'NN
under rpnhad on the date this application is filed, (date of filing):
COUNTY AUDITOR
❑ 1 (We) own 0 Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
E] Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of daurant ( name)
Social Seaaity number of clamant (but five dg&)
Drivers [license I Identification I Other number
Iswing
State
of claimant (last five digits)
/
Name of ciacranYs spouse (
Social Secruiry number of daimant's spouse (last frve digits)
Drivers license I Identification I Other number
Issucg
State
of daimant's spouse (last five digits)
CONTRACT ••. s
If burying on contract Fee Simple owners name
Recorders office where contract is recorded
Record number Page
ao
PROPERTY DESCRIPTION
County
Township Taxing district (city, town, township)
Parcel number
Legal desorption
Is the property in question:
'
0 Real property Annually assessed mobile home (IC 6.1.1 -7)
If any portion of the residential structure or the land not exceeding ane f) acre that immediately surrounds that structure Is used to produce income, describe the use and potion
of the property utilized to produce Income.
aD7
oa —
��_�y_i8 -aoi- �.
PROPERTY BY CLAIMANT
IN OTHER COUNTIES
Count' Township
County
Township
I hereby certify the above statements are true, correct and complete.
S'
re of claimant
r
\1
k
1.
Address (number sheet te, and ZIP e)
ale 4
rJ r. to
ASSESSOR '
NON-RESIDENTIAL
AT100%OFTTV
I VALUE VALUE
Land not exceeding 1 (one) acre Immediately
�t--as"�,r- ,,, -_,E+` - �'=
surrounding residential improvements.
Other land
(2)
Y'rti,
Total land (line 1 plus line 2)
(3)
ng
(4)
�v3.� v Al
i�'isga..txasa�s ;. vi�'l
Residential improvements or Annually
Garage
(5)
y:_5x,'z`zx�.tKZa h
Assessed Mobile I Manufactured Home
Other improvements
(6)
Total improvements (line 4 through line 6)
(7) .
Total value (line 3 plus line >)
(8)
1 hereby certify the above is true, correct,
Signature of Assr_ssar
Data signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Data signed (month, day, year)
STANDARD DEDUCTION
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 &1.1 -12 to a nabrle home that is
$
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one -hatl (12) of the assessed value of the mobile home or manufactured home.
Signature of Auditor
Date signed (month, day, year)