Homestead_Hasenour (9) "v CLAIM FOR HOMESTEAD PROPERTY TAX\ M
YEAR
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. _ STANDARD/ SUPPLEMENTAL DEDUCTION FORM
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State Form 5473(R13/12-09)
\,ate Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for tiling instructions. ' 11-1 a
. • CERTIFICATION STATEMENT - .
I(We) /ix � as
♦ i� �- i_t_ �..,� certify that I(we)occupied as my our)principal
place of residence or am/re)buying the following des sod real property for which a Homestead Property Tax Stand peductioq,{$(tereby claimed
under contract on the da e this application is filed, (date of filing). I(We): I CU I Q
❑ Own ❑ Am(are)buying under recorded contract ny
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation Cr1�1(u/�
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified perssonaf rec1 cefiru lUDITOR
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
- .. -- . ... �� :. :' x <-" CLAIMANTS INORMATION_. .ti.. t-- -. .7 71•-;_, v� _.r_.� := ':
_ a, ._CONRACT RE65665 -._ ; m x
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number I Page
. ., _ 5.:... , PROPERTY DESCRIPTION4u y a 4 r'�.` '- - .
County Township liming dis . (city,town,township)
Parcel number I,gggaal description ,a_hi _ ii Is the propel ty in question:
/ £ 5w 5 .O / A c- I ❑Real property ❑ Annually assessed 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 utilized to produce income.
A6, - .2 X - /a - 300 - ooa . y62 -o .zy
s c,: 1 ROPEERTYJOOWNED BY CLAIMANT IN OTHER COUNTIES .- lit.;-_;._;e
County I Township County Township
I hereby certify the above statements are true,correct and complete. ignature • •aimant, A , `�J`°/`�'`p��/
\ Address(number and street,city state,and ZIP code) Q� (�y�/(
I
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. _ . - .- _
ASSESSOR USE ONLY - TRUE TAX,VALUE
ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL-'
- _ - . -. .-- -s „..„......1-s., . a:=AT100%,OFmTTV_ _.__+VALUE .-- - VALUE
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/Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits 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-hall(fit)of the assessed value of the mobile home or manufactured home.
Signature of Auditor _ Date signed(month,day,year)