Homestead_Linxwileru
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CLAIM FOR HOMESTEAD PROPERTY TAX
CERTIFICATION STATEMENT
YEAR
STANDARD / SUPPLEMENTAL DEDUCTION
FORM
❑ I (We) own ❑ Am (are) buying under recorded contract
State Form 5473 (R1216-09)
HCto
INFORMATION
S / Prescribed by the Department of Local Government Finance
Social Security number of
)'
Social Security number of claimant's space (last five dlgds) Driver's license / Identification I Other number Issuing State
of claimant's spouse (last five digits)
CONTRACT ••r r
If buying m contract, Fee Simple owner's came '
Recorders office where contract is recorded Record number
Page
PROPERTY DESCRIPTION
Cm
Township
Taxing district (dry,
P &vPll`
Legal tle
Is the property in question:
a Y'
sp7 ��
❑ Real property ❑ Annually assessed Mobile tame (IC 61.1 -7r'
If any portion of the residential structure or the Land not exceeding one (1) acre that Immediately surto Inds that structure is used to produce Income, desa@e the use and portion
of the property utilized to produce inaxne.
PROPERTY r BY CLAIMANT
IN OTHER COUNTIES
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant s -
Address (nuaftr and speet, dN, state, and LPaude) p n n
5 vI /
0,
'y NON-RESIDENTIAL
TRUE TAX VALUE ASSESSOR USE ONLY AT 100% OF TTV I VALUE VALUE
Land not exceeding 1 (one) acre immediately
O
surrounding residential Improvements.
R 'tr:4'
Other land
(2)
.'�^,�OK�V
Total land (line 1 plus line 2)
(3)
Dwelling
>a
Residential improvements or Annually
Assessed Mobile I Manufactured Home
(4)
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Gars a
g
(5)
' .gem:g
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Other improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
STANDARD DEDUCTION
ME
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherproAsbn, the sum of the deductions provided in IC 61.1 -12 to a mobile home that is
$
not assessed as real property or to a manufactured home that is not assessed as rael property may net exceed
one,haff (12) of the assessed value of the nobde hone or manufactured hone.
Sign
Date slgeetl�pm�dU �'