Homestead_Doerner (9) -
CLAIM FOR HOMESTEAD PROPERTY TAX �'d?T�
�' `; STANDARD/ SUPPLEMENTAL DEDUCTION F•!3'
State Form 5473(R13112-09) H!I' lama
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. MAY 0 8 2014
2' :t w tta ' - aTR'wvn ` `' �tl°�"•- r'`EERTIFICA lON'STATEMENT 'tzt-R ij4z _+^�'('s �?s-•fs' ;:A
I(We) `�� ll ! ,V1. 1ZW1/4/taprb, certify that I(we) ..:._/�.FycIll•S Principal
place of residence or am(are)buying e following described real property for which a Homestead Property Tax StraiH&nid@OpiWPRIANl°PrUR
under contract on the date this application is filed, (date of filing). I(We):
WI; ❑ Am(are)buying under recorded contract
►1 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 personal residence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
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y _�,..��,. �,.`�' � �,���.•, ��4�; CLAIMP:NT,�SIINF�ORMATION�y ����:i�ay�� ,..abe.�.:l'?1,,.,t, �is'�r.�.,s��t€fr
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d:-� e�n+✓riG_.4��tT� '�',_��_li�.li��.. ar, C� d,b•L.�.DI'�
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
S"-.<u.v-2} 's .�O'u'fs".`tail£- PROP,ERTpY DESCR ITION sf.,.`_ lf.'is r ...,.jiLi€04 i'. "+.:>.F.�.1-/k..t:'+{taw 7.3 t
County Township T • district(d town,township)
Parcel number Legal description Is the • •party in question:
7ir Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)ace that immediately surroun•s that structure is used to produce income,desaibe the use and portion
of the property utilized to produce Income.
c_- sf' 1 r 7'" lagOPER;YOW D'BC MAhTMVOTERCOUNIES 3 i. a _1,,7AVIna. °s-1:0
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of` •ant
(number and street,oil,state,and ZIP code) /y1 //^G /D
* �� s-Pl"e-tra .t`.'',� fi TR E TAX VAL l A SEISED VALUEt."ieRi MESTEAD`�ive,hON RESIDENTIALIp L",,,°y!}
ASSE`SOR USE.ONLY , � illitATk100%a OF rwariii&WAL•UEeg' C Y c—WI VALUE s r e ihd
Land not exceeding 1(one)acre Immediately (1)
surrounding residential Improvements. - "
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Annually Dwelling (4) . 1 5 1,-,-c •
d
Assessed Mobile I Manufactured Home Garage (5)
Other Improvements (8) _-..->._ •
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 Mc csor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
P}a7 ; .-€4-14,'3' s'3.,`�r tWk'gt41,211..,YgANDARD DEDUCTION ALLOWANCE=b. i..c -'i'-a i._?- , }i.� .c?S' .,m_ .�24d at+ 's,°liM
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwifhstand/g 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.
Signature of Ndi Dam signedamonth,Is year)
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