Homestead_Mayer (8) Z... CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
� a STANDARD / SUPPLEMENTAL DEDUCTION FORM
State Fonn 5473(R13/12-09), Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for tiling instructions.
CERTIFICATION STATEMENT "
I(We) S . Ski - — x! certify that I(we)occupied as my(our)principal
place of residence or am(are)buying th-ollowing described real property for which a Homestead Property Ta n r d on is hereby claimed
Il �1
under contract on the date this application is filed, (date of filing). I(We): 1H�
I
fie( Gig / )
ry Own ❑ Am(are)buying under recorded contract
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation Nov 7 9
❑ Have a beneficialinterest in the trust or the right to occupy the property under the terms of a qualified personal resldenclOUt
❑ Am (are)the shareholder, partner or member of the entity that owns the property. ,
`_3s.:_ -'t_-T 1: •t --._ LE.. -- .CLAIMANT'S INFORMATION- -- - _ 2 a`iii r-— . v C:r T' =k:,
CONTRACT RECORDED,!'
If buying on contract,Fee Simple owner's name .
Recorder's office where contract is recorded Record number Page
I
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.f?ROPERTY.DECRIPTION
County Township Taxing district(city,town,township) _• _ ... _
a
Parcel number Legal description Is the property in question:
/A • / ❑Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding•r (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, — / S- 3es. - 30a - coo 3 /o - 009
.- ��. s ... _ .
-PROPERTrYyOWNED BY CLAIMANT IN OTHER COUNTIES- -
County Township County I Township
I hereby certify the above statements are true,correct and complete. f daiman ,,,,f / `
Address(number a string"' ,st.'a,and ZIP cod- I , \ //1/'C/!/
{/ lg./, ASSESSOR USE ONLY -_"-ETRUE TAX,VALUE d-AAT"100%OF.TTVEI HOMESTEAD E - .e NON VALUENTIAI '
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 1 Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits 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(112)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)