Homestead_Yeargin 'c„t, CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y
� STANDARD/SUPPLEMENTAL DEDUCTION FORM
*3' State Form 5473(R13/12-09)
- Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. g f. r
-sitel - s ?gili CERTIFIATONp TTEMENT Le " kei
:Wi
I(We) x. � _ A a .ar�rsa ' . n
certify that I(we)
occupied as my(our)principal
place of residence or am(am)buying thl allowing de i.bed real property for which a Homestead Property Tax Standard 8 1u LU l4s hereby claimed
under contract on the date this application rs filed, (date of filing). I(We):
MAT LU
❑ Own ❑ Am(are)buying under recorded contract /)t n r
El Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation JNIxL'r„r,.^.,�Pc7-'Ly.—'.,x"7^i^i
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualifidakaistiliii6g1WENTeYtrea D ITOR
❑ Am(are)the shareholder, partner or member of the entity that owns the property.
•' 141:fi int �, ra..i+r ±S`'S'A'3�;'�...''+ .1'"g.I IANT.:SfINFO AT10�N'5.. ix skii".2411— aiii€h
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yy* . £`'- il,"s�.;i?1,4 ,'�, ..!�,i hie 7;;;ti`ti 'CONTRACTjRECORDEDuy.>iz' s 4 tta.m'tc:s ttaw._
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
; = t*._5•'4... ✓t:.exearaxYt�Y � PROPERT4YaDESGRIPTION �„';1:z?fs,,'`i�+.•••v eatgt�` .,,...�+a'7rs�WeiPA'°
County .M`,,'.. Township Tatting district( ' t con,township ,t
Pa I number Legal description Is property in question:
[�/1'�
co-(g %-tea-%,1.1 9> Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceed ng one(1)acre that immediately surroun that sWcture is used to produce income,describe the use and portion
of the property utilized to produce income.
se 'C IX:ti •�-r"v f itt.5 j3ePROPE13137OWNED BYJCI:AINI ANTZIN10 RICOIINTIES aalgt e.1:s.„z.fgreirrg:,.a14 A
County Township County Township
I hereby certify the above statements are true,correct and complete. Signs �daim nt� �•
Address(number and street,city,state,and ZIP code) I
giA A S SSOR USErONL r l�h �,gTRUSE 707t7LUE �fASSESSED VALUipmziESTEADcS 5J ON RESIDENTIAL .5=.
roiv _�.w=_.ns:rzswcv w... .. ' t...gwa kr n. ---- - reATi100%.OFET,T,V iVAL•UE4:7&N Y.s1.t +_tVALUE t arA. Ott..
Land not exceeding 1(one)acre Immediately (1)
surrounding residential Improvements. - - - - - -'-
Other land (2) - -
Total land(line 1 plus line 1) (3)
Dwelling (4) a it t 'r - .-k.'.
Residential Improvements or Annually
Assessed Mobile l Manufactured Home Garage (5) err? -.;x �A- r� r ..-
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.
Verifying action-Signature of Auditor Date signed(month,day,year)
-. Y” "<.4.X . ti )� . : K 'i. ....r. S -:�z s. 1: w iv'-rim:
..�:;�+ -,r���v ���e, �.a,,tny�` �STANDARO�DEDUCTtONI+L'LOWANCE,}.��„.',� � �!�;4-11S1 -�-�e,�°.�:�:�--,`,Y.:,
. .. sm ._� . .. �. �._..._-_
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 re property or to a manufactured home that isnot assessed as real property may not exceed
one-hell(12)of a sled value of the mobil or manufactu home.
Signature of Auditor f/C--) Date signed(month,day,year)