Homestead_Cantwell zCLAIM FOR HOMESTEAD PROPERTY TAX SEAR r
STANDARD / SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R13/12-09) HC10,a Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. O�/ p�j
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CERTIFICATION STATEMENT •
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I(We) r,11 I '/ r i. i/ i.. ',Id, — a' .. -.- d certify that I(we)occupied as my(our)principal
place of residence or am(are)bu ',the foll•,ing de- bed real property for which a Homestead Prope and ereby 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 AUG 2 6 2014
❑ 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.
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CLAIMANT'S INFORMATION
Name ofd nt(legal name) -I���
Social Security number of claimant(last five digits) Driver's license /Other number Issuing State �1
go / (') of claimant(last five digits) D/Z 9 .� l!/
Name imant's spouse(legal name) 7 7� �/�
Sod Seaint vbeero cia�u Lsppouse(asfive digits) Drivel Identification/Other number Issuing State
////// / 6 7� of claimant's spouse(last five digits) oO / �_
[f� CONTRACT RECORDED //�/
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page ,
PROPERTY DESCRIPTION
County Township Taxing distil (city,to , ship)
Parcel number Legal description Is the properly in question:
I M meat property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surroun s that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
a 6-6 . - a5-6a.5"- 003. 730‘7 0/7
. PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true,correct and complete. Signet
of claimant /� , e n `
Pddr (numb rand street,city,state,and ZIP code) ' I f0✓ a
LfL�69 ead [euc ( Ed / ra21ehn, 11■1 47(o140
ASSESSOR USE ONLY I TRUE TAX VALUE AT E00°E OF TTVE I HO VAELSU EAD I NON- VALUENTIAL E
Land not exceeding 1 (one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4) '
Residential improvements or Annually
Assessed Mobile I Manufactured Home -
Garage (5) •
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)
STANDARD DEDUCTION ALLOWANCE
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 properly 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)