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Homestead_Schmidt (2) ""^v CLAIM FOR HOMESTEAD PROPERTY TAX �}1 nEAR STANDARD I SUPPLEMENTAL DEDUCTION �j-{ � S•.._ State Form 5473(R1216-09) J_�� / •', -/ Prescribed by the Department of Local Government Finance q 0 INSTRUCTIONS:See reverse side for filing instructions. ', C 2 7 2012 CERTIFICATION STATEMENT I \ I(We) // ' e �� t&• - cacti that I(we)o¢up,\.,ell a • (our)principal place of residence or a- (are) •uying the following d•- bed real property for which a Homestead Property akSgYdattig lati 4hIPEly claimed runder contract on the date this application is filed, (date of filing): u {J I(We)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 personal residence trust CLAIMANT'S INFORMATION C . [--- -- - - — ---- --- CONTRACT-RECORDED-- -- ----�— — -- -----If buying on contract Fee Simple owner's name Recorders office where contract is recorded I Record number • l Page . PROPERTY DESCRIPTION I County I Township Tagdng .ca](city,town,township) Parcel number Legal description Q Is the property in question: ii -6.)C3 nQr�+�(g[a.,t4, $'o 7/y ❑Real property ❑ Annually assessed mobile home(IC 6-1.1-7) If any portion of the residential structure or the land not exceed'ug one(I)acre that immediately surrounds that structure is used to produce income,describe the use and portion of the properly uaf¢ed to produce income. 21b -a3 -l& - 2 D DO A . LK ? - 0 1- 9/ - _ . PROPERTY OWNEDBYCLAIMANT.INOTHER COUNTIES.-__ County I Township County I Township I hereby certify the above statements are true,correct and complete. Signature d claimant / / /�� /Address(number and street,city,state,and ZIP code). T y �// - X rlt> Y )1 i P •Jd Y.9iXdr�l�l•]@I1:7*-YIU4:fil/1_l Land not exceeding 1(one)acre immediately O jig f-`�- V surrounding residential improvements. 1 = _ ^ �. Gu Other land (2) ..,'�•4','�F,l-",k..-y,. ¢` Total land(line I plus line 1) (3) Dwelling (4) -" . -x b-3c fa "". ... .. Residential Improvements to Annually - s or Assessed Mobile/Manufactured Home " -' '"'� agiWrte''rr is Garage (5) I�t�'ta'�'",�.;�?-� .i,."`�:�`�4r... Other improvements (6) 1 Y^"--j gsi VI 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. Ve'dying action-Signature of Auditor Date signed(month,day,year) STANDARD DEDUCTION ALLOWANCE 1 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 OM of the assessed value of the mobile home or manufactured home. Signature of Auditor Date signed(month,day,year)