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CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
i�� STANDARD/SUPPLEMENTAL DEDUCTION FORM
xf6:i..y-< State Form 5473(R13/12-09)
zat Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. I ','i
_ .v errja -r. - a t' 'ai ERTIF,ICA710NjThall ENT" '{3 jir-ri-„-,Fy1 `4 .,:mss rittth
I(We) 031- Q a" ArY1" 274M L/M. certify that I(we)occupied as my.(our)principal
place of residence( am(am)buying the following described real property for which a Homestead Property Tax Stands/41041416n 6,11Weby claimed
�urtd contract on the date this application is filed, (date of filing). I(We):
p�.Own ❑ Am(am)buying under recorded contract 1
/❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation ((:: Rp�SO"N COUNTY AUDITOR
p Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pekonarresidence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
:< x-.` s v
�'z' :trlsir'u.,a lie wa.W?xaa{a C..
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
-I qF air > ,�, Ta+^ ^y ii;;,; , "` ;�° -• ry ,r' ggiW
;.s'i _ ���{...,ta`'��''ns^f3�-1.x2.,`�'.�'+ `L^.���....�-��'- t�l �'f��� P,.ROPERTtYxDESCRIPTIi.N,xa't�. 'w.s...�:t:4�><a-�-5��.�' • :..>,��,.k•;rT^s��°�s.-:'
Cott Township Taxi g . (cft town,townshi.
,
Parcel number I I Nethe pperty In question:
I�Q Real property ❑ Annually assessed mobile home(IC E,.,-n
If any po •' n f the residential structure or the land not exceeding one(1)acre that immediately surmu ds that structure is used to produce income,describe the use and portion
of the p trr¢ed a produce Income.
074- /02-/an- 2id- 003. o2/oz - 6J a'
i:` - *: v.RtW-a }b,PROP,ER;Y OWNED 13:ii'M I OTHERTCOUNTIESw ;/S-$_s= t- -+^-i4ii 'w
County Township County Township
I hereby certify the above statements are true,correct and complete.
Signature -claimant %Ad dress(number and street.city state,and ZIP code) l'(�G�✓
3o/ ol/vE DR. /,)c E To .2--e-). -V,‘")0
x°-s ^%'e"t-x11.4- %ijk rlit'l -T�'ASSESSEDVALUE I1£''HOMESTEAD NON RESIOENTIALf"-v -`t`
.,„_ v'4 SSE�.SSOR;SE"; LY2n titatI�TRUE;TAXxVALU EyI*ATd100.°/aOFJTtT,Vu'f. .tadWLUEb� � T' VALUEiiaraiihi
Land not exceeding 1(one)acre Immediately r ` 4 -s
surrounding residential Improvements. (1) -' -c- -
Other land (2) ..-,
Total land(line 1 plus line 2) (3)
. ti=c.- ';.•+.
Dwelling (4) cif t r r e z-.
Residential ice vements or Annually
Assessed Mobile Manufactured Home `i" '. - " x- °ii-.
image (5) zrn ::..,..:
Other improvements (6) .}r• '-- -r.. t: i.t
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits fine 7) (8)
Signature of Assessor Data signed(month,day,year)
I hereby certify the above is true,correct,
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
ANi��� <icre re ,30xVarl` grSTANDARD DEDUCTON _LOWANrEar " `
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 toe 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.
Date signed(month,day,year)
Signature of Auditor . .