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CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
% STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R13/12-09)
HC10
, Pres cribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
CERTIFICATION STATEMENT., — - _
I(We) ila--` / r _• /L..�_��� WPWIlr. '- -- I( e)pccupipp': , :�s / r)principal
place of residence or am(are)buying the following described real pry'-rty for which a Ho estead Property T Sta ar dt/6be11 I - eby claimed
under contract on the date this application is filed, (date of filing). I(We):
❑ Own ❑ Am(are)buying under recorded contract SEP 8 2014
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation nn,,
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified persooallrsitle�e
entity property. GIBSOTTNNNNN������C COUNTY AUDITOR
❑ Am (are)the shareholder, partner or member of the enti that owns the
- . ! '_ . _ - ';_-,aCL-AIMANT S INFORMATIOV': _1-;;, _< „_1I7 Nate,,. ' ,°-�Ct�j`lai- -
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
-._ -_ - r
- . „ '-= =- Pf20PERTDESCRIPTION -"- _ a.? _ `+ i '---- \_ _ ,
County Township Taxi istrict(city,town,township)
Parcel number Legal description Is the property in question:
IT w)pi& 3a -3- to ❑Real properly ❑ 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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
.Z6, -/4- 3a . goo . 00o . 9 _ o )., Y
.__ _ 7. _ ,a.—,_ -
`��'- PROPERT'YOWNEOiBY CLAIMANT IN OTHER COUNTIES, ,�_
County Township County Township
I hereby certify the above statements are true,correct and complete.
di Sign.ture of daima� te �/
- _ r .!__
Address(number and street,city state,and ZIP code) I / ;
as O / 7_
e - _ ._$_'‘ ASSESSED.VALUE HOMESTEAD lNON-RESIDENTIAL `'-"
ASSESSOR USE ONLY I'TRUE TAX,VALUE,L-AT 100%,OF_TN•-I. .. .. VALUE
Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line I 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)
. _. _
_- - BTANOARD 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 property may not exceed
one-half(12)of the assessed value of the mobile home or manufactured home.
Signet of Auditor Date signed(month,day,year)
ww.+ xc �o �ers
Przscribe0 By SWte Board of Tax fqmmi55i0ner5
To & Fi1M in Duplicate
CLAIM FOH HOMESTEAD PROPERTY TAX CHEOIT FOR YEAR 19 ?9
SEE BACK FOR FILING INSTRUCTIONS
��(WP)� lf�� �--��-�-��( �• b �-�%F certify that on the 1st day of
arch, 1 2� I, (We) occupied as our p ncipal place of sidence the iollowing described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial iryter�st in the taxpayer
Property Description
Taxing District (6iFy; Fewn; Township):
Parcel Number
pD� 0097�-�a
o�G-�9 /ao-�ao. �7a-a��
:ounty Township
or legal description shown on tax statement: _
,� %� NLcI� 3�--a-io �9. 9z�3a.�
If buying on contract: Owners name �'� ��mo1e owner) -
Contract recorded in Recorders Office - Record
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 utilized to produce income
Any other counties in which individual owns or is buying real property:
��hereby certify the above statement is true, correci and complete.
County Township
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land � � � � �
Total Land
Residential Improvements Dwelling
�il! :: i979
Garage
�/�(�`� Total
Other Improvemen s'r�
AUDITOR
Tr�mprovements�� Line (6) plus (7) equals (8)
I y ce�Fi(y the above is_ true. correct. and complete.
SignaWre ol
True Cash
Value
( i ) So 0
(2) �z.S O
(3) �7�
(4) �O �O
cs� i 7 9 a
(6) � � ZO
(�) �i 5� � O
(g� �/ 3 3 O-
- ACTION BY AUDITOR -
Assessed
Valuation
.
�. .
Homestead
Valuation
-�� '
�
s =a s�-
Daie
Date: —�
7