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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R4 I B-00)
INSTRUCTIONS: See reverse side for filing instructions.
as our principtl place of residence the following described real Property for which a
FORM YEAR
I IO C
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EE
o#ed ❑ Are buying under contract
a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is burying under a contract.
CONT
If buying on comma Fee Simple owners name
Reoorder's office where contract is recorded Record number Page
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K-qt-20-cs C-RIP—Ind
County
Township Taring district (city, town, township)
Pmoel num r
(27 - !N) L4 I to orl -6J
Legal description
- P-LIJ 11 q- 9's - 149
If any portion of the residential structure or the land not exceeding one am 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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County Township
County
Tmnship
I hereby certify the above statements are true, correct and complete.
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n re of daimant
-en bez, d street atyAtate. ZIP code)
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VNOMESTEAD
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Land not exceeding I (one) acre immediately
surrounding residential improvements.
IN
W
Other hand
(2)
pk?� ip
Total land (fine I plus line 2)
(3)
Residential improvements
Dwelling
(4)
1 WE 04.
Garage
. WIN
Other improvements
(6)
W INER
Total improvements (line 4 through line 6)
(7)
Total value (Fine 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Mditor
Date signed
RW 20 _ Pay 20
Lesser of 12 Homestead
Valuation or $6,000 $
Signature ofAudilor D8!7jf 1 q