Homestead_DearingCLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT /STANDARD DEDUCTION
Slate Form 5473 (R5110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for (ling instructions.
V RM YEAR
10 0�
I (We) V it WItiY l-/ - 1-u I L cefi&that on the 1 t day ofWch, 20
i c
(We) occupied as our principal place of residence the following describ r I property for which a Homeste ad ,P�o`rJ C� Cr Is hereby claimed: El l(We)owned El Are buying under contract /
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buyQiitideract.
a:iCONTRACT'RECORDEDPa"` -��
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
4i ] +
.-_.<_.. :.. - �.. 1. .PROP,ERT.Y:.DESCRIP.TION�t,...
County
Tomship
I hereby certify the above statements are true, correct and complete.
Taring district (city, town, township)
)later bar
//1((�� 0
Legal D 9r
T
AT�100 %:OFTN
the property in question:
/
� T Q
Land not exceeding 1 (one) acre immediately
Valu tion or $6,000
/ Real property ❑Mobile Homo (I. C. 6-1.1-7)
If any portion of the residential structure w the
of the property utilized to produce income.
land not exceeding one (1) acre that immedi 1, 1 uZat s cture is used to produce income, describe the use and portion
(vJ.J.�
surrounding residential improvements.
1
Da igned � /
.=�'-"' X33- v��e' s „=PROP,ERTY,OVYNEDiBYCLAIMANT, IN: OTHER' COUNTIES,` k„..9s.,.„,;,,'�- '�,.'..;"r;'!^
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of I imant
'J
Adoress (number 77 t. city, stet ,ZIP code-
S )
4
3 +tee -.YAZn y- i�•+��Yi�}* 3i1i J
a,h vASSESSOR USE ONLY�i3 }
i4- .ViVR
p TAX , at<
ASSESSED VALUE
ii f
HOMESTEAD x
.% y�
NON - RESIDENTIAL”,
.�`'
..;? a_,r- �gg;r:. „a;r'�.u.&
rTRUE
vrVAI:UE.>
AT�100 %:OFTN
VALUE+
i.,,g -.f, VALUEst�^`pp
Land not exceeding 1 (one) acre immediately
Valu tion or $6,000
°�-
ry* kii K y ;t'I. R lY
surrounding residential improvements.
1
Da igned � /
Other land
(2)
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)
y
Residential improvements
k�EEd.
k.bn u.0.,d: -MMU
Garage
(5)
,.,`v�e�s`,gi
Other improvements
(6)��.:fz
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
r-'s.• 2Yi<m,Goa . iv4- iii;• ? -:STANDARD:DEDUCTION'ALLOWANCE,
20_Pay 20_
Lesser of 1/2 Homestead
$
Valu tion or $6,000
Signatur of ditw
Da igned � /