Homestead_Deal (8)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R1216-09)
1 �' ,•, , Prescribed by the Department of Loral Govemment Finance
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INSTRUCTIONS: See reverse side for filing instructions.
t IF.W-M
APR 7 2010
Property Tax AN1d�1 ATis he)L MSlmed
under contract on the date this application is filed, (date of filing):
t+ 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 daimant (legal name)
Social Security
Social Security numtwl of imam's spouse (fast five digits) Drivers license I Identification
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CONTRACTRECORDED
If buying on contract Fee Simple owners name
Remmers office where contract is recorded Record number Page
PROPERTY
County
Township
T Astrid (city, town, township)
Parcel mumlI r
Legal description
1 the property to 9 esdon:
l —
14,
I props ❑ Annually assessed mobile home (IC 6 -1.1 -7)
If any portion of the residential structure or the land not exceeding me (1) acre that immediately sunounds that structure is used to produce irroorne, describe the use and portion
of the property ublaed to pmduce income.
PROPERTY • r BY CLAIMANT
IN OTHER COUNTIES
County Towrahip
Ccunry
I hereby certify the above statements are true, correct and complete.
Lure of
nt
ress (number and street, city, state, and ZIPcode)
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I J ) / V
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ASSESSOR USE ONLY TRUE TAX VALUE [ASSESSED VALUE I -HOMESTEAD NON-RESIDENTIAL
AT 100% OF TTV I VALUE VALUE
Land n exceeding 1 (one) acre immediately "yr -k ` -+�++ a•r. u;�rjx'?�l
ce
surroundot
in residential improvements.
Other land
(2)
ae• Vii, ^. ^.r•.
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)ry�•
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
ti• z' �'d; -. 31- +.Zfi ^ -.
Other improvements
(6)
d?' ' -� �`' � - �•
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
STANDARD • r
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NoAudhamni irg any otherpmvision, the sum of the deducuionc provided in IC 6.1.1 -12 to a rnobr7e home that is
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rot assessed as real property or to a manufactured home that is not assessed as neat property may not exceed
one -hall (112) of Ne assessed value of the mobile home ormanufartured hortta.
Signature of Putlitor
Date signed (month. day, year)