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CLAIM FOR HOMESTEAD PROPERTY TAX
d STANDARD It SUPPLEMENTAL DEDUCTION
i State Form 5473 (R1216O9)
.� Prescribed by the Department of Loral Govemmem Finance
INSTRUCTIONS: See reverse side for filing insluclions.
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CERTIFICATION STATEMENT
N ITOR
I (We) "fy that I (we) occupied as my (our) principal
place of residence or a are) buying the f owing described mat property for which a Homestead P -rty Tax Standard Deduction is hereby claimed
under contract on the date this application is led, (date of filing):
(We) own El 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
claimant (leg tame)
"�• Vvv
N a of claimant's s (opal name)
Social Security number of dalmant's spouse (&S five dgas) Dmcrs license /Identification I Other number Issuing Sate
f imam's spouse (
If buying on contract, Fee Simple owners fame
Recorders office where contract is recorded Revd number Page
PROPERTY DESCRIPTION
County
Township Tang district (cam town, ip)
Parcel number
Legal descr`iation Is the perry br question:
• l teal property ❑ Annually assessed mbile home (IC 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) am that immediately surrounds that structure is used to produce Income, describe the use and portion
of the property uffu ld to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER
County Township County lowrahip
I hereby certify the above statements are true, coned and complete.
Sgnaa 1
Address (number
cilll meet, -. state, and LP )
Y��u. by
3 �
ASSESSOR USE ONLY TRUE TAX VALUE ASSE.
Land not exceeding 1 (one) acre immediately ;T.,c'��j.:X
( 1 )
surrounding residential improvements. 3:i- .*K.s:,k- _i'a.'- °;;.- SL: 'M;a
Other land
(2)
;-:F
.
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
5-
VNN,.�a
Residential improvements or Annually
9' a1�.S's`s3sC.Kf3?YiS. F✓•;
Garage
(5)
>b(''�#�,xY, ?i.;>$F4•.
?$ Y &>�io^Twct-
Assessed Mobile [Manufactured Home
Other Improvements
(6)
l"' -,�2�
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
' hereby certify the above is true, correct,
Signabrre of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Data signed (month, day, year)
STANDARD DEDUCTION
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notaithstandirg any otherpro'nslon, the sum of the deductions provrded in IC 61.1 -12 to a mobile Irome that is
$ '
not assessed as reel property or to a manufactured home that is not assessed as real property my not exceed
one-half (112) of the assessed value of the mobile home or manufaWred home.
Signabxa of
Date signed (month, day, year)
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