Homestead_Ping (3) t:+,_ CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
�-' STANDARD/SUPPLEMENTAL DEDUCTION FORM�' State Form 5473(R13/12-09)
Presrnbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. I g I '•`
g-t - c' - F r n ti w.. v S..n-°.,4&-w lit .>?�.fr`^n �- r3
��r�t�'.,�-���,L,-w: Lya�" +�c�`. f ii'.t'>�4'�a"e�F�e2/�: CEiRTIFI�A�TI+O�N�STATEMENT�,".�:��'.,z�.��ssf ''�..^ksTrelr��-c-.'•ss -e• ?.£'�u.
I(We) ..r i /II �R�nr i."1--e_�<f�r certify that I(we),°soupi e�1n1a�stmy(our)principal
place of residence or am(am)buying the following descri• 4-I property Q ich a Homestead Property Tax Standard DeBuRia s hereby claimed
under contract on the date this application is filed, (date of filing). I(We):
❑ Own ❑ Am(are)buying under recorded contract GIBSO
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation N COUNTY AUDITOR
❑ 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.
cer.frirl i� r4ta ti Vitva wNT.S t-NOIRNI,A TIONrt-ttg+W1 aWi n SR- 3'�: . 1 ; .;.+'
ie ae-."ti i T ¢ a t«�-,. `t1 t '-17
s.-,3"'.�l�ml"tcm+3.-�i.t.�1-+�i-ar e•�3�"''�''P�-`t'!�.'3uG_wa•�GCONTRACT�RECORDEDasczt:'?;+��-��`�-.s�`"'�:-s9.�`*Yz.�tr:-fit .. �. � "�Si ..eE'st.•:
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
`^ { 1yir) 1 v 4t;:!•c . PROPER TYjDESCRP�TIO`yal". '"a g - ralkiatf a "S%
county •Si , Township
4 IA clink 'Ad ....
Pa•- number '��y� L-•=I description I�f((��``t{��hee7''��7..ttipppp''''rr__�_�_uupert in question
-IO—�- C) •.r to �/ al property ❑ Annually assess• ••.i a home(IC 5-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately sunou u that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
•= K ;,tla_WtW *); atilir.PROPE it_WWNEIT33. L707N9 IN OTHER atiartIESLat .r-S-„r_' 4': a4.Fek::• $
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature o +:imam /`/
Address(number and street,city,state,and ZIP code)
a
V ? ,¢"?n }3,4te. Y-/ils .41-ct.r3.T g,, p.214 +�.zr;'iX�J orsiV`='fp SESSED VALUE)E�HOMESTEADkt i;Pse. oru:RESIDENTIAC:Al ,
t_. ASSESSOR USE,ONLY' 2nT•,�.I TR. UEiT ;VAL•KE I� s. -c .4s. .VALUE c' -E
• SCEs, a._c.wwr•�.•I§..;=1.ry.ai`ge:: ci Ut.a,.ATa700:/.OF TT,Va;f :xVAL"•UE- '+. t
Land not exceeding 1 (one)acre immediately � jr.: t
(1) -1` rw. k:-. ..
surrounding residential Improvements. _ 7.*- `^ '
Other land (2)
Total land(line I plus line 2) (3)
Dwelling (4) +v"t.5',3 `'STM r +x £.,r
Residential Improvements or Annually
Assessed Mobile I Manufactured Home - s Garage (5) 5.s" y` gt'ir' '-` -t -
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.
Veriihh!ing action-Signature of Auditor Date signed(month,day,year)
3.aNA` AVOZ4?;s'�LI `3.-.'" 4Sta- NDARDDEEIUCTIONALLOWANC EtailZt4�?'ys fatilt'? "s•ti.4P: .;.5ry. •irt'
:,. ?`i .36.,..�. �.4'S{"�+Y�7dI:Y._ .).__ ._1s=. -a ._:(• . a_-.w.e7l. .dr..-
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 properly may not exceed
one-hail(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)