Homestead_DavisE
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CLAIM FOR HOMESTEAD PROPERTY TAX
i4._, = STANDARD / SUPPLEMENTAL DEDUCTION
State Fonn 5473 (R12/6-09)
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Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for fifing instructions.
1 YEAR
c
JUN 2 5 Zulu
CERTIFICATION
I iwe) 4" certify that I we / ) ed a
oppl s (our) principal
place of r sid am (are) buying the following described real property for which a Homestead Property Pa�9fi 'NaQJ(GIAtlItEybdtUpp}M,yy( claimed
under on a date this application is filed, (date of filing):
0) (we) own C1 Am (are) buying under recorded contract
Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
❑ Have a benericial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of claimant (legal name) T� (�
lJl /V UQ
Social Senmty number of daimannLiDst five d'
Drivers license I Ideniifration I Other
Name of claimant's s se (leg name)
�e e
Social Secunty, number of Imam's spouse (last five tlig1s)
(
/ �./
CON-TRACT
It buying an contract, Fee Simple owners name
Remmers office where contract is recorded Record number Page
•. r
Coon
Township
T th (city wn, unship)
S
Parcel number
L al escnp' V the property in question:
Real property, ❑ Annually assessed mobile home (IC 61.1 -7)
any Po a residmilal structure or the land not exceeding one (1) a at immediate surraunds that structure is used o produce omrns, describe the use and portion
'If
of the p utifred o produce income.
/rjo/(J
/0/ {. co- /OHO✓ —awo
R •• • r BY CLAIMANT
1.17111
IN OTHER COUNTIES
oil. 1 1.
County Township
County Township
I hereby certify the above statements a2 true, correG and complete.
s' nature o imam f
Addr (number rid sweet, eery. state, and ZIPCod
B
• • ASSESSED • r NON-RESIDENTIAL AT 100% OF TTV I VALUE VALUE
land not exceeding 1 (one) acre Immediately 1 �•c; `'•-` "�.,?,-�.•�$
surtouridin O residential improvements. - 5.:,' ?- >.��,�snc,.::?•.�..z3ru`s:.,•.
Other land
(2)
i=r t`.tv
- e_ - -- - ��-t•`'
Total land (line 1 plus line 2)
(3)
Dwellin
(4)
F
'`•1"ia`''gtQ.c.S'I -t •�,ft'-
.c+ ua9
- t3s'i c.�Yi. ti viii •r,"'}
Residential Improvements orAnnualty
Garage
(5)
Assessed Mobile I Manufactured Home
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Data signed (month, day, year)
STANDARD • r
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NoMthslandfng any otherprevision, the sum tithe deductions provided in IC 61.1 -12 to a mobile Mme that is
$
nor assessed as real property or to a manufactured home that is not assessed as real property may mat exceed
one -half (12) of me assessed value of the mobile home or manufactured home.
Signature of Auditor
Date signed (month, day, year)