Homestead_LoftonCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
State Forth 5473 (1113112-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
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DEC 15 2011
I (We) certify that I (we) Deco a (our) principal
place of residence or am (am) buying the following describecc6l property for which a Homestead Property 1�t1 §gRPf''A419 y claimed
at 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
❑ 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.
Name of claimant (legal na )
�
Social Security number of daimant's spouse (last rive digits) Drivers license I Identification /Other number Issuing State
of da4nant's spouse (last five digits)
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
• . a
Egg=
County
Township Taring district (city town, township)
Parcel number
Legal description
Is thOrproperty in question:
Efl,z,f al S'
❑ Real property ❑ Annually assessed ,.lade home (IC 6-1.1-7)
It any portion of the residential structure or the land not exo#ding (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
o d,e property utilized to prod" Income.
-oa- �C? 00- 000. 0 va -0�9
.• .:
Township
County
Township
County
hereby certify the above statements are true, correct and complete.
igri of clatman
Cyh
Add (number ant street, ntY• state, ant Z/P code)
X1.0 1�eec�� 1f2 �c n
• • MVRCrt s
Land not exceeding 1 (one) acre Immediately
(1)
surrounding residential improvements. - ' -•'-
Other land
(2)
Total land (fine f plus lure 2)
(3)
Residential Im vementa or AnnuaOy
Dwelling
(4)
Garage
(5)
°'-` - z= •1r• >i
Assessed Mob e I Manufactured Home
Other Improvements
()
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above Is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Vailymg action - Signabae of Auditor
Data signed (month, day, year)
r. -.. . s
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherprovision, 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 gal property may not exceed
vw4mf fit) of the assessed value of the rnobBe horn or manufactured home.
Sign/s� a of Auditor
Date signed (month, day, year)