Homestead_Wolk °' . CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD / SUPPLEMENTAL DEDUCTION HCRO
State Form 5473(R13/12-09)
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Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. 420 la 1109 $/, 02 9 3/6 9-5
.. �" � �. CERTIFICATION STATEMENT
I(We) � id0-G,( , certify yy am� upi sur)principal
place of residence or am(are)buying the following described real property for which a Homestead Property Ta n rd eduis 3 f claimed
under contract on the date this application is filed, (date of filing). I(We):
LyDwn ❑ Am (are)buying under recorded contract OCT 6•
2014
❑ 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 personallResidence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property. , AIi
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- CONTRACT RECORDED - - r
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page•- - - --f?ROPERTY.DESCRIPTION -
County Township Taxing district(city,to township
Parcel number Legal description Is th- or°erty in question:
Real property ❑ Annually a Assed mobile home(IC 6-I.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 utirmed to produce income.
0y ,L1 i8 - io 'y-00t 'y3 / -007
PROPERTY<OWNEO,BY CLAIMANT IN OTHER COUNTIES_ - __ -- - _ ,.,
County !Township County Township u
Sig Nre o claim a}— .
I hereby certify the above statements are true,correct and complete. � J� . .L,(797/421
Address(number and street,c s •te,and ZIP code)
/1 C' ?� - i/_'/.;- e �' v7L ..
ASSESSOR USE ONLY LTRUE TAX VALUE AT E00°/`OFTTVEI HOVALUEAD� I NON-RESIDENTIAL.
Land not exceeding I(one)acre immediately �-. -
surrounding residential improvements. (1)
Other land (2)
Total land(line t 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 property may not exceed
one-half(1R)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)