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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 16-09)
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS. See reverse side for filing instructions.
I'. r
APR 5 2010
CERTIFICATION
Standardi W f ; V claimed
"under �ICC30N CO
contract on the date this application is filed, (date of filing):
❑ 1 (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 terms of a qualified personal residence trust
INFORMATION
Name of claimant (legal name)]
K
Social five dgae)
Driver's license I Identification I Other
Namp claimant's spouse (legal naIDp)
Social Secrmty number o1 imanat's espouse (last five dgas) Driver's license I Identification I Other
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorder's office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County
Township Ta a g disma (cdy' town, rw
Parcel number
Legal description • 3o oq • Is the property in question: 4
�%[. d - ,®'Real property ❑ Annually assessed mobile home (IC 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that suucture is used to produce income, describe the use and portion
' of the property utilized to produce avnme.
- 000.719 -0i
PROPERTY OWNED BY
County Township County Township
I hereby certify the above statements are We, correct and complete.
Sg rwf claimant
tlress (number and street, arty state, and ZIPoode)
J,::- Le q 9-1
P a z 1-e ton WAP yo
ASSESSOR USE ONLY
TRUE TAX VALUE ASSESSEDVALUEJ -HOMESTEAD 1. NON-RESIDENTIAL
I I AT 100% OF TTV VALUE VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
or Annually
dal improvements
Dwelling
a efa �' 2 "vs
•_
Garage
-• `
ed Home
Assessed Mobile I Manufactured Home
Assess t
Pp
Other improvements
(6)
x
*� �`• +I
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 71
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
STANDARD DEDUCTION
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
NuNAthtlamfing any otherprovision, the um of the deduariorss provided in IC 61.1 -12 to a mobile home Nat is
$
I
not assessed as real property or to a rtanufacured home that is rot assessed as real property may not exceed
one -hall (12) of me assessed value of the mobile home or manufactured home.
-
Signature of Audi=
Date signed (month, day, year)