HomeMy WebLinkAboutHomestead_Bender (2)0
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"' CLAIM FOR HOMESTEAD PROPERTY TAX
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STANDARD If SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 /6-09)
ra / Presented by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
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CERTIFICATION
I (We)
cerliry�lv+�)^Cb�5f11N'NaRtmncipal
Place of r sidence or am (are) b ng the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this #plication 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
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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 da' ani (legal name)
Soda] Security nurtber of last five dgds)
Drivers license I
(legal name)
Social Security number of claimant's spouse (last five dgns) Drivers license I Identification / Other number
Issuing State
of claimant's spouse (last five digits)
CONTRACT ••• r
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number Page j
PROPERTY r
County
Township Tarin it tint (city, town, township)
Parcel number
Legal description 3, 30 9
Is the prop
in question:
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F N E a
eat property 0 Annually assessed mobile home (IC 6- 1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
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PROPERTY OWNED BY
County Township County
Township
I hereby certify the above statements are true, correct and complete.
gnaw t dai
Address(numberand street, dry, state, and Zlecode)
766 SF 7N
7G(oS
d -S bS 42 n3 ✓i 12
•- USE ONLY TRUE-TAX VALUE ASSESSED VALUE
AT 100% OF TTV I
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Land not exceeding I (one) acre immediately 1
surrounding ()
residential improvements.
Other land
(2)
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Total land (line 1 plus line 2)
(3)
Dwefling
(4)
Residential improvements or Annually
Garage
(5)
Assessed Mobile I Manufactured Home
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Dale signed (month, day, year)
and complete.
Vaifying action - Signature of Audiwr
Date signed (month, day, year)
STANDARD r r
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherprovision, the sum of the deductions provided in IC 6- 1.1 -12 to a mobile home that is
$
net assessed as real property or to a manufactured home that is net assessed as real property may not exceed
one -hail (12) of the assessed value of the mobile home or manufactu d home.
Signature of Auditor
Date signed (month, day, year)
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