Homestead_Allen a CLAIM FOR HOMESTEAD PROPERTY TAX F YEAR
Mc-Alt STANDARD/ SUPPLEMENTAL DEDUCTION FORM R
v.
X4 State Form 5473(R13112-09)
z,�., Pmstated by the Department of Local Government Finance 11--1 % cp
INSTRUCTIONS:See reverse side for filing instructions. S'l o`Ti Ica p 4019 L7
yPrc _ ��.•v�p�'�l1O�F� CERTIF ICATION7 ATEMENT�-'-"Ytl,.+F,t-'�,'."reiai r._. ..n' 3Ra -=
I(We) \ • ll �i ��af ii1 I ! 4_• .. certify that I(we)occupied as my(our)principal
place of residence or am(am)buying the following described real property for which a Homestead Property Tax Stan djC'Dd� n is fey -
under contract on the date this application is filed, (date of filing). I(We): ��
❑ Own ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation JUN It 6 2014
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence tors
❑ Am (are)the shareholder, partner or member of the entity that owns the property. +
•
Brat-' - lik;.'n+sr3z:''''taiiF. - CLAIMP:N'�■T�S�INFORMATION"s`.'{v; 'x�Vi1.tG$ca` :°- eahairgij ai\n'••..
Name of da ant(legal name) : • I III , • I I 41 '
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Na claimant's spouse(legal cam ) /
1d�\,�1O-�1}�p
OSLO drr�
— i-5Z�. 3a aaFr3'Ivn..-avi ;} vt>
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page! '
.t +:+ 1-ri;4 ,ttc*;F fcS. - •-N"i7 ....:F',.+ "^�.�'�trr ° ' m- . " .rtra"'i il:.y?C, -.•
'g',f''�` �:�1���ac;�a..r.•r=4� :.r_�,a> 's�i•r P,ROP,ERT.YJDESCRIP,TION;^y,''�.m'�'rE„�'rFs? r�.c,.,��. .�.�.
County Township T ' of trio((city,town,township)
Parcel number L I desaiption I 1 , Is the property in question:
4$rt l y- [teal property ❑ Annually assessed mobile home(IC 6.1.1-7)
If any portion of the residential structure or the land exceeding rronet,(11))--a"cre""that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
a to- 1s. - 3 lo- ki 03 coo la 3 9 - 00
•i_t•',' `#nlikat ” M" ltytPROP,ERTY,.'OWNED BYTCLA1MAr�T'IN�OTHER 000NTIESa3'=' t te:_ (�v,. rti--.=cam•
a�M1.�a.�....s�r.° 7�.-.���_` .�k"i�iki�.� �.s 1 L ��? � c� T3;k:'
County Township County Township
I hereby certify the above statements are true,correct and complete. -‘re of i rii ^ 4t, Q -
Address(number and street,city,state,and ZIP ...
(�-\1 \X)
�f 1 ,'� ♦ \ 1t ' •s 1� 6J
=.t*14V R ajar '-x^ .':�Yi! e?Vir— y �^: lF1174'- - ' ItpSSESSED ✓ATIEWI OMESTEAD:+ ,tit 'NON RESIDENTIAL) �'.
�eMy ' ASESSOR USE!ONLYxu TRUEITPJ(VALUE I v o
-- ;' . ../a.."m.rm: w..uwu � �N-+X �:ri.9'AT4100/1OFtT.TVe".F •d.VAL•UE " � 'v`i`t1" 'sE VALUE a-y `°-^t:
•Land not exceeding 1(one)acre Immediately y'r "
surrounding residential Improvements. (1) aft 1-•
Other land (2) . ---r,L- -'
Total land(line 1 plus line 2) (3)
Dwelli 4) _-.?t`< n- i'x :3•' t-f
Residential Improvements or Annually -t7 _
Assessed Mobile I Manufactured Home Garage (5) `-,- .__ s R /...-.
Other Improvements (6) F - %'-, .
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.
Veifying action-Signature of Auditor Date signed(month,days,yyear)
3 '°'�•�v'ti d�� :rSTAN.DARcoEDUCTiON),7 OWANC at,:::.. `'ter-;mss deer-tp: iiaat,'Sr:i.%
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductbns provided in IC 6-1.1-12 to a mobile home that is $
not assessed as real properly 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 Auditor Date signed(month,day,year)
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