Homestead_Hyatt CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
_ A STANDARD / SUPPLEMENTAL DEDUCTION OR
r
State Form 5473(R13/12-09)
.� ,e 1 Prescribed by the Department of Local Government Finance FOR
,_
•
"CERTIFICATION STATEMENT
_rr
I(We) LS af/ t.� ..lea._ ��.. sue/ certify th- (we`*.'..'-d&esr/iy'es principal
place of residence or am are)buying the following described real .roperty for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We): 0 C I 2 9 2014
❑ Own ❑ Am(are)buying under recorded contract
❑ 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 Pg(gS9@lre R
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
., _
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number 1 Page
- -=L - - yr -.. k.r.P,ROP,ERTY DESCRIPTION.,. •_ %„-,, , - •
County Township Taxing district(city,town,township)
Parcel number Legal description IL ription �1 3 4A Is the property in question:
' - PrI • I - —) x ..� 4 ❑Real 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 surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
A0 - 17 - 1d - cloy- coo. ii2. - o ;. J-
_ `` PROPERTY OWNED BY CLAIMANT IN OTHERCOUNTIES r
County 1 Township County Township
I hereby certify the above statements are true,correct and complete.
ignatu ft .
/Address(number and street,city,state,and ZIP code) _ / -71V//J/
x F4 • 141
7 ASSESSED VALUE' HOMESTEAD NON-RESIDENTIAL
ASSESSOR USE ONLY_ "I-TRUE TAX VALUE I- I ,. I --
:r m s., -. . .:� a:.9v AT100%--OF_:TTV- „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 I Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
hereby certify the above is true,correct, Signature of Assessor Date signed(month:day,year)
I 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(1/2)01 the assessed value of the mobile�homeeoorr manufactured home.
Signatur of Auditor 7t, •""�`-+`� Date signed(month,day,year)