Homestead_AskrenCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
S• State Form 5473 (R12 16 09)
.� ,•,• .j Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
AUG 1 9 N99
QRjLW&j]QNSTATEMENT
I (We) certify that I (we) as my (90 principal
place of residence or am re) buying the following described real prope y w v4A,�, .....:mestead Property Tax Stand, d Wj h&Ld%TS ned
under contract on the date this application is filed, (date of filing): o
❑ 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 terns of a qualified personal residence trust
INFORMATION,
N of daimant (legal name)
r
Social Security O Lo
Drivers license I Identification I Other
Issu'
'w ^�` .....
of claimant (last five digds)
Other land
Name of claimant's spouse (legal name' (�
he a P, r.
Social Security number of claimant's spouse tray rive aa/�st ,.ars license I Idendfcation I Other Issuing State
of claimant's spouse (last five dg2s)
CONTRACT RECORDED
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township
Taxing district (cit)6 town, ip)
Parcel number
Legal desai Is the property in question:
(•JM ( I ❑ Annually mobile tome (IC 6- 1.1 -7)
Residential Improvements or Annually
Assessed Mobile l Manufactured Home
perry assessed
portion of the residential structure or the land not exceedbg orb (1) am that immediately surrounds that structure is used to produce income, desrnoe me use are gotten
property ubffied to Produce income.
at,-C)ti -j\ - 70a.31c)-7 -ol
County
Township
County
Township
I hereby certify the above statements are true, correct and complete. I V�.'VU . -A I� I .. A n I A r A
Land not exceeding 1 (one) acre Immediately
;{+ a' �"•.�;�.. ,Tj ' >.' +`
surrounding residential ire rovements.
(1)
'w ^�` .....
Other land
(2
Total land (line I plus line 2)
(3)
Residential Improvements or Annually
Assessed Mobile l Manufactured Home
Dwelling
(4)
Garage
(5)
„4t a' °'sy -ii.�✓' u} 4], A
`� iird 3i
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
Dane signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
hate signed (month, day, year)
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Nolwilhslanding any other provision, the wm of the deductions pmv/ded in IC fri. 1 -12 to a mobile home that is
not assee m as real pmpeny or to a manufactured home that is not assessed as real properly may not exceed
onehad fl/) d the assessed value of the mobde home or manufactured bums.
of Auditor