Homestead_Lamey r CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
>' STANDARD/ SUPPLEMENTAL DEDUCTION OR
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�r;=M: State Form 5473(R131 12-09)
` ' Prescribed by the Department of Local Govemment Finance
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INSTRUCTIONS:See reverse side for filing instructions. ��S�,
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w CERTIFICATION ST_/.TEMENT ""-��.:�a� -.G+�� •?r.`, yC^��„��'
�1 principal
I(We) 4 I_ re i!�_ , / iii Lal e .... , . certify
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place of residence o/am(are) �ying the following described real props Qr ich a Homestead Property T S n edu is - claimed
under contract on the date this application is filed, (date of filing). I(We):
Own ❑ Am(are)buying under recorded contract APR 3 20 14
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 person. residence trust
partner or member of the entity that owns the property. .
❑ Am (are)the shareholder, pa ty P PeM� �/�R►I.
s "3gring .-g,E � n- -MiClt.X IM4711T11RaWf1O naa� Y :Wi
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Name of
Name of claimant's spouse(legal name)
Social Security number of claimant's spouse(lest live digits) Driver's license I Identification l Other number Issuing State
of dabnant's spouse(last five digits)
ajita��,'�3�,'3?`zY`,t .ai+*`�-•� =c >' cONTRACTjIRECORDED a G
If buying on contract,Fee Simple ovmels name
Recorder's office where contract is recorded Record number Page
SFsirai..;:4),:e24'. x a°:A.Flb . #.Y`.° .5 , .-F ROP,ERTY DESCRIPTION ,:.e'er% :74.f.�. .3n3 '"-�+ C:Fil' ry14t
County Township Taxing district(cdy,town,township)
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Parcel number Legal description Is property in question:
Real properly ❑ 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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3ROPERTYi(-3 o jCLAIMTAh' O);HER COl1T s-ra-p.nzi ?,1- -ff .(sw:..c -#.. .
County
Township County Township
I hereby certify the above statements are true,correct and complete.
Signature tu of claimant /)
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Address(number and street,ary,state,and ZIP code)
X 592? E Co 5 o.Pl i 'A eli -,cl V76 51T
a - r-++--7„6--., x`P,. Kz74 rts” ai sz'a°' '> " 'ASSSSED VALUE vHOMESTEAD 1I e'P z NON RESIDENTIALl' ,tfx
a P.SSE�S ttORaUSE ON YYY +,{ JaTRUEtTAX,V UE-vi -a +�'..f VALUE '1A Ci-J r'4.
Land not exceeding t(one)acre Immediately (1) G„ -9 � 1-e - -'.
surrounding residential Improvements.
Other land (2) K 1,- -�3
Total land(line 1 plus line 2) (3)
Dwelling (4) ' _-.. `h !f Lt i r/-i
Residential Improvements or Annually
Assessed Mobile I Manufactured Home Garage -
(3) a' t .-�t...
r
Other Improvements (6) . '".sue4.-, .-'vix •
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
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)
?+i glis`t.4 k-4" AWI F e ° :A'#" `' irefANDARD DEDUCTIONSAL OWANCE .. - }ga g yr -;' tt- affaGtx`41
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 property or to a 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.
Date signed(month d year)
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