Homestead_Shoemaker s t, CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
.Ci'}, STANDARD/ SUPPLEMENTAL DEDUCTION OR
....v: State Form 5473(R13/12-09)
�l Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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�•,u5.�1�1 ..,_�x`gu�°ssr'"-.�z"�,aa°�Yiit� _Rf rTATEMENT i...7.'..€,-�l�a.:��.�s1.�r a.r..r.T s.�k'-:.«.x
I(We) / SV� � —f. - certify that I(we)occupied as my(our)principal
place of ide ce or am(are)buying the following described real property for which a Homestead Property Tax Sfarq� �p dp�'on imed
under niract on the date this application is filed, (date of filing). I(We): 9 q p
own ❑ Am(are)buying under recorded contract g 1 ,fLJ
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation quit 20;4
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal rest nce
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
W . a tinaMts-1 •.sI v .. CLA1_I ANT'S' OR
NFMATION $ d,7r 1"' rl•. h..,.: „L :•f r'i xs
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
W.MalfS. ,'"ni. nn?.&.S`^R ':;5C,ax;.r$r7iae�+.s•" P IP,ERTtY DESCRIPTION. '• r.. wadi n: :17ii .il.S. i SitcW, 7,sk of
County Township Taxing district(city,town,township)
!P.a rced n r L-• I description
v-1-o2.01-1 -1603-01,0. btta / U y Is the property in question:
❑Fteal property ❑ Annually assessed mobile home(IC 61.1-7)
If any portion of the residential , dare 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 looms. a 7
'WjMS, tai a l PROPErftWE NEDrgasMA(rjN.OTER OUNTIS - LO j ' VC a1s i
County Township
I hereby certify the above statements are true,correct and complete. If. / /
Address(number and street,d0:state,and ZIP code) 1 . `7 LS . " - /
#J,'n�-+'�'�+"5-.4K /C a-7- tkreo_c i. `fe�^-- - '"r g-'ii3i�+°J ' 4-§-§ESSED VALUE iiLiHOMESTAD'.t�' .f NON RESIDENTIALl`' '`3
y�y ASS3 SO�USE ON�Y,y y-(+�Fs` ta� T E�eaTAXrVAIUE�I.ATT,100°lo OFsT,T,Vi --nlavAL'UEss Y isp VALUE i-.re. Yzi.-
Land not exceeding 1(one)acre immediately r
surrounding residential Improvements. (1) iecit f E
Other land (2) ..,>
Total land(line 1 plus line 2) (3)
Dwelling (4) r fir t t. -:r .c- e--'-
Residential Improvements or Annually
"t '` -
Assessed Mobile I Manufactured Home Garage (5) -0:, < x
Other improvements (6) .•- . :..:
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Data signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day.year)
f^y{*y.'^ +)r' '45>5 a i3.ti%Wi7r'='r'+• cry,t.il 7ANDA130.19 OCTIO 15:11E5WANCEI ayt,4`'^*iilfisS^47T41 ,sl •rrr.3`_ `. asM
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 mad property or to a manufactured home that is not assessed as real property may not exceed
one-hag(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor _
Date signed(month,day,year)