Homestead_Kramer (3)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
Stale Form 5473 (R1216 -09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS., See reverse side for filing instructions.
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CERTIFICATION STATEMENT
I (We) certify that I (we) occupied �s myX4WW ER
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
contract on the date this application is filed. (date of filing):
.gunder
Lb I (We) own ❑ Am (are) buying under recorded contract
lHJ 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 terns of a qualified personal residence trust
INFORMATION
Name of cla" 1("a) )
Soda] Senility rxanlber t (last fre dgh;) Drivers license I ldentit'
Name of claimant'
Social Seamy number of daimant's spouse (last five digits) Drivers license I Identification I Other number Issuing State
of claimant's spouse (last five dgits)
CONTRACT ••r
If buying on commM Fee Simple owners name
Recorders office where contract is reamed Record number Page
PROPERTY DESCRIPTION
County
Township T d (cilyitpwn, township)
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Parcel number
Leg esaiplion
Is the D Deny in question:
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l property ❑ Annually assessed mobile tome (IC 6-1.1-7)
If any portion of W 96sidential stuctrWm or the land not exceeding one (1) am that immediately si nmxm that structure is used to produce income, describe the use and portion
of the pmperty utpbd to produce income. oO�•
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PROPERTY OWNED BY
County Township County To•.mship
I hereby certify the above statements are true, correct and complete.
Signatu claimant
U
Address (number and street, cry; state, and ZIP code)
ASSESSOR USE ONLY. TRUE TAX VALUE JASSESSEDVALUE1 HOMESTEAD . r
AT 100% OF TTV I VALUE VALUE
land not exceeding 1 (one) acre immediatey
sumoundin re sidential iop rovements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
Yu
Own-
Residential Improvements or Annually
(4)
Garage
(5)
Assessed ed Mobile I Manufactured Home
Other improvements
(6)
1 1
Total Improvements (line 4 through line b)
(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
Data signed (month, day, year)
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20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Nohvifhslandug any otherpmosion, the sum of the deductions provided in IC 6- 1.1 -12 to a mobile home that is
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not assessed as real pmpedy or to a manufactured home that is not assessed as real property may not exceed
-
ane -half (1)2) of the assessed value of the mobde hone or manufactured hmle.
Signature of Auditor
Data signed (moth, day, year)