Homestead_Wagner (2) ,\ CLAIM FOR HOMESTEAD PROPERTY TAX , . YEAR
t: STANDARD/SUPPLEMENTAL DEDUCTION
ff 'T, State Fonn 5473(R13/12-09) r
— Prescribed by the Department of Local Government Finance JUN 2 41°'
INSTRUCTIONS:See reverse side for firing instructions.
r : a hti a?::.-wc3',HYcn CERTIFraMk N)STATEMENT a.. �.-g+. `Y�'i' ' y`hilrlda ,.QCs iY.4=4;:iit,•
I(We) /i/.< re //L /I cei, �f1 •••• . ol3TQQ(our)principal
place of residence or am(are)buying the following described re-furoperty for which a Homestead PB j)�r 9&n••a • Deduction is hereby claimed
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 /f. C.!'a .(2.,
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qua lied personal residence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the
property.
`�"A� yr � �a fi itZS -
CLAWANTySFATION � �+ k-W ±< 1 -
�a'` '.�w.raY;:.�"%a��`i�.�t�i�r4�u'�`v:�,
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
4.w :� e� u r ` - "" `" O ° 'F ""apt? ,r.-. t -6 t`•`.4 rr•.: <:.
���..`� � �t�x�r�v� K�isx,,y� 4t "";`�` P,ROPERTtYaDESCRIP�TION„d� aT .L'.�"tY`',�i.....i�e•°=s<s�.1:1-fw�F .tee`��..au ae
County Township vie
�!s I__r_.1L _L
Parcel number Legal description Is the property in question:
teal property ❑ Annually assessed mobile home(IC 6-1.1-0
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,tl–• •:the use• •portion
of the property utilized to produce Income. �..Z ,
CUo / ?-is �'/- � 866 0a c �, . ,
F" ?u 'I' ,�' etv yssc P,ROPERT�tOWNED'BY CLrAI Af:i'IN OTHER COUNTIES: . a`g.:Igoe4_- r't' ' °£e f"'+SP
�� . -#3 �8es�ma<;ti3r::$r.�?� S'i�,.8� L..J._. . r'�- __6_S .S_.. . .a...._`7.�..:S:.e.�v.-.c.�^f7nvL4S.sS
County Township
I hereby certify the above statements are true,correct and complete.
of - ':'.a •; + * yfr'n" '`{n}jz»a•^ '�+`R�"-rs'llpti'-d ASSESSED VALUE I="r HOMESTEAD Ir 44rNON RESIDENTIALI y 4+Lti
yASSESSOR'11SE ON Yi I:TR. UE;TA7t\VA,LUE„IIrSATI;190:/,OFIT,TVA.'S. ialVAL•UEa t,S,r_:a: ^"1VALUE < ' .r;•'`i`E
r.. eu.rocuxr6h
Land not exceeding 1 (one)acre Immediately - _ -
surrounding residential improvements. (1) -3~
Other land (2) ._... i 4.--..i.-
Total land(line 1 plus line 2) (3)
Dwelling (4) -' - 'is t.r ..c
Residential Improvements or Annually
Assessed Mobile I Manufactured Home Garage (5) `_,*'.7.7-....-,...;>--34.,..:e-."4.-:/-'. -. '
Other Improvements (6) `... -
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 Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
r��y.`„�'�,"u1554 aizea7a TMinkri�e�`rj"�STANDARDDEDUC:fON ALLOWANCE oWltay ang,e�':ia,..ig ti....
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 rmnhile 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,year)