Homestead_Marx (4)I"
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ZeCLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM State Form 5473(R13/12-09)
�1, Prescribed by the Department of Local Government Finance -
INSTRUCTIONS:See reverse side for filing instructions.
CERTIFICATION STATEMENT
I(We) i � Lk 4/ certify jr- I e 'ed as my(our)principal
place of residence or am(are)buying the following described real property for which a Homestead Property r- Stria Deleby claimed
under contract on the date this application is filed, (date of filing). I(We):
Own ❑ Am (are)buying under recorded contract AUG 2 6 Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation 2014
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified peg/ al residence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property. G/
CLAIMANT'S INFORMATION .
CONTRACT RECORDED
It buying on contract,Fee Simple owner's name .
Recorders office where contract is recorded Record number Page
.I
PROPERTY DESCRIPTION
County Township Taxi 'strict city,(own,township)
Parcel number L esaiption '/ party in question:
/S`' ���/ / / Real property ❑ Annually assessed mobile home(IC 61.1-7)
It any ' n of the residential structure or the land not exceeding one(1)acre that immediate rids that structure is used to produce income,-describe the use and portion
of th p perry utilized to produce income.
-C1a-/ /do_ ooa, .S-03_oaf7
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township u
I hereby certify the above statements are true,correct and complete. Sgnaman
tn
•.dress(number a •street city,state,and Z •code / �/�/
ASSESSOR USE ONLY TRUE TAX VALUE 1 AAT 100°E OF TTVE I HOVALUEAD I , NON-RESIDENTIAL
Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Annually filling (4) .
Assessed Mobile I Manufactured Home Garage (5) •
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 phs 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 S45,000
Notwithstanding any other pmvision,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,year)