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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
State Form 5473 (R121609) ,
�O Prescribed by the Department of Loral Govemrtrem France
,�
❑ 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
INFORMATION
Name of ( al name)
Social SecuTy rxm6or t (last me dgib)
Social Secruity rwmber of claimant's spouse (last five digits) Davies license I Identification I Other number Issuing State
of claimant's spouse (last five digits)
CONTRACT ••r
If bu ' g 9QX= ct. Fee Simple owner's name
Recorder's where contact is recorded Record number Page '
PROPERTY
County
Township Tahmg tlb - la ip) �1C�_
reel n� ber
LA
a-(J
(1
Is the property in question:
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Real property ❑ Annually assessed mobile Ipme (IC &f. 1-7)
If any portion of the residential stucaire or the land not exceeding onto (1) acre that immediately surrounds that structure is used to produce Income, describe the use and portion
of the property utilized to produce noorre-
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Ccunry Township County Township
I hereby certify the above statements are true, correct and complete.
hire of 'mansl(�f
ress (numQ and sfrae� stare, andiPcode)
/
1� f, 1,
rmt 0.i �N l ! {C
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• VALUE I HOMESTEAD NON-RESIDENTIA
ASSESSOR • LY
I AT 100% OF TTV I VALUE VALUE
Land not exceeding 1 (one) acre -Immediately -r'-
(1) -�'
surrounding residential improvements. -
ONer land
(2)
- :•, :1 '*,- , -�
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
0
Residential Improvements or Annually
Garage
(5)-
++1r-aA•r -k *i
Assessed Mobile I Manufactured Home
Other Improvements
(6)
�-
Total Improvements (line 4 through line 61
(7)
Total value (line 3 phis line 7)
(8)
I hereby certify the above is true, correct,
Signature of Assessor
Data signed (nronth, day, year)
and complete.
-
Vitrifying action - Signature of Auditor
Data signed (month, day, year)
STANDARD DEDUCTION
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Nohaithotardeg 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 sssessad as real property may not exceed
on (1 fine value oft1niolide home or manufactured horn.
Sig tore of Pod
Data sgnad (romdu paK