Homestead_Rainey a CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
A,� ' STANDARD/SUPPLEMENTAL DEDUCTION
+' State Form 5473(R13112-09) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTION :See reverse side for filing instructions. , ,'
A MITaltr .z fac'en7r °' -'b- ,.t...srr;�a*T`€'?fir -tt r t<•'N;.0 W` ` v.,}x -
- � ERTIF.ICATION STF,TEMENT �� '� s �r.,� �,s� { «Pk�t�� is
- 'I(We) 1,17 a.��I����7� in MA r AI % • a r certifyr1i,,1li�a I fywel )kupied as my(our)principal
place of resi.ence or am(are)buying the following described real property for which a Home 4 d Properb}tax£Rdarrd Deduction is hereby claimed
under con'-don the date this application is filed, (date of fling). I(We):
El Own El Am(are)buying under recorded contrail <))TOR
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation cll./nailed COUNT Y AU
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qunailed personal residence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
Rik _ �: ...�r-F :,a Ta --,t r CLA MAN,T§117ORMATIONFst%+_ A ss`alig + •'+`y*:W2R'; k
'-�',��+.�5�,r; in_ •43 ( �'�} � ��1CONTRACf RECORDEDr - �v�- nr,
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
::. i w: ;_g+ atyggt p4�0 PR O D-ESGsRIN OIitra" W z3gre 't12,� raeE - �iZ ^:
County Township Taxing district(dry,town,township)
n egal d Is the property in question:
- -/S-ICO' 'D.�• Or a4 ❑Real property ❑ Annually assessed mobile home(IC 61.1-7)
If any portion of the residential structure 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 Mitred to produce Income.
' c n k- PROPER I WN Iril jCWERjCOUNTIESs'if ia:" xJ r rz ;ka
County Township
County Township
Va
I hereby certify the above statements are true,correct and complete. re •f daima '
L\.
Add number and street,dry,state,and ZIP code) / V O3 . 1 2-60 S lay LJ /c T -
;1 - 1 SStEda USE'ONLYtiV 1r, ~*`1 UEA XIVALUE ASSESSED VALUE 'HOMESTEAD ''l 4r' ?'NON RESIOENTIALi li_7F.
, yes.._ ...A1,„wrwae„Ic- -.,•-•...r? ;`»y , s=1i TRUEL ATE100,°!o OF T.T.Vtiii('e: VAL`•l)E` ."It tdL';']-�":i:VAL'UE �i, ` r7L
Land not exceeding 1(one)acre Immediately
surrounding residential improvements. (1) .) i "; a
Other land (2)
Total land(line 1 plus line 2) (3)
'rte pr'
ResIdential improvements or Annually Dwelling (4) i. _'•',}"c&7- « y ai
Assessed Mobile/Manufactured Home Garage (5) '>' _- .,5+^..t i
Other Improvements (6) .!1s-:-.1 s=.-
Yvt
Total improvements(lined through line 6) (7)
Total value (line 3 pits 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)
. .3'€-ly -s• q s- 5 F` rr sgSTANDARD'DEDUCTIONrALLOWANCE;T-` Ye s.4f > r'4} X�"'
:.�r'fr.?, �.b' �s. i�+�?i ssn .eY�+�Se...- .. .r -... ._ . �__-._ . .^std.^... X'K;. .:tr..-
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 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,yew)