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" CLAIM FOR HOMESTEAD PROPERTY TAX
A STANDARD / SUPPLEMENTAL DEDUCTION
i State Form 5473 (R1216-09)
�O B Prescnbed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
T' HC10
III
CERTIFICATION STATEMENT
I (We)
certify (w) occupied as my (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Pmper, , n rd D"ci(rbn is hereby claimed
under 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
[=� ��U C
❑Have a beneficial interest in the trust or the right to occupy the roe 3rtWAQP rs Or '�
g py property rty under the terms of a qu R rest a ciefiiTs
INFORMATION
Name of daimant (legal e)
Social Security
Social Security number of claimant's spouse (last five dgits) Drivers license I Identification I Other number
Issuing Slate
of dabnam's spouse (last five digits)
CONTRACT ••r r
If buying on canuaM Fee Simple owner's name
Recorders office where contract is recorded
Record number Page
PROPERTY
County
Township
Taring district (- ,
ip)
PagA pu
Lyq$I Qesrn'p�
Is the property
in question:
OOJJ�7 (f ^ 2 /�%:.:v'n.
�sWJcturere oror
C�iTL.IWI l!
eel property ❑ Annually arse mobile home (IC &l. r -7)
any portion of the residential the land not exceeding one (1) acre that immediately surrounds that structure is used to produce Inane, describe the use and portion
'If
of the property utiru to produce income.
PROPERTY OWNED BY CLAIMANT
IN OTHER COUNTIES
County Township
Ccunty
Township
I hereby certify the above statements are true, correct and complete.
daima
Address (number
J� s t jj;0 cod :;nfie [f
r
ASSESSOR TRUETAXVALUE
USE ONLY AT100%OFTTV
• • • r
I VALUE VALUE
Lanrrd not exceeding one acre immediately
)• a 'c --'s� +"r`_; -: +w
tial improvements.
suoundin residential
Other land
(2)
_ ^._'`w�4_.'< "sa.v:''i4i
Total land (line 7 plus line 2)
(3)
Dwelling
Residential Improvements or Annually
(4)
°-" TF'd"x '•Pgt;�y3
Garage
(5)
Assessed Mobfle 1 Manufactured Home
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 71
(8)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Vairyvg action - Signature of Auditor
Data signed (month, day, year)
I STANDARD DEDUCTION
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any wherprovision, the sum of the deductions provided in IC 6.1.1 -12 to a mob& hone that is
S
Mass as real property or to a manufactured home that is not assessed as real property may nt exceed
one -haft of the assessed value of the bde home or manufactured home.
i
Date signed{ h- drr)
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