HomeMy WebLinkAboutHomestead_Dewig (3)"'" LAIM FOR HOMESTEAD PROPERTY TAX FORM YE�
4.._ �} STANDARD / SUPPLEMENTAL DEDUCTION
S StateFOrm5473(R72/6-09) HC10
�� : PrescnCetl by the Department ol Local Govemment Fnance
INSTRUCTIONS: See revarse side far �Jirg instruc[i0ns.
I(We) ce fyCthal I("f e)� pied as my (our) prindpal
place of r sidence or am (are) buying the following d 'bed real property for which a Homestead P T2R StanIIard Deduction is hereby daimed
under mnVact on the date this applicadon is filed, (dafe olfiling):
❑ I(We) own ❑ Am (are) buying under remrded conVact �'/� ,Q
v �
❑ Am (are) en6lled to occupy as a tenant-stockholder of a cooperative housing corporation n�� v a ��TOR
� Have a benefidal interest in the wst or the right to occupy the property under the rerms ���Aper��al FB�i ence wst
spouse
spouu
I/ buying om m�trac4 Fee Simple o.mefs �ame
Remrdefs ot&¢ where mntrad is recordeA
Caunry
Township
of da'unant (laz( frve tlyrts)
of daimanCs spousa (las( frve d/gits)
�,
Tarirg disiricc (rity, rown, fownship)
State
Remd numbu I Page
-,I y��w -y�O O_�• ^�I desaiPtion I Is �h❑e pmPerty in questlon:
i� •J
{' (��Gi � Real property ❑ Annually assessed mobile hOme (IC 6-1. f-:
�If any portiai of Ne residential swcW re w Ihe W�W no1 exreeCirg one (1) ave that immeEiatey surtwnds iha[ swcNre's useC to protluce income, desrnbe the use anE por6on
of tlie pmperty uofaed ta produce inoome.
Counry
To.mship
I hereby certiy the above stetements are we, cortecl and complete.
acre immediauy
ONer land
Total land (line 1 plus line Z)
Dwelling
Residential improvements or Mnually
Assessetl Mobile 1 Manufactured Hwna Garege
Olher improvements
i�)
c2�
(3)
(4)
(5)
(6)
a�
7
Township
ToUI improvements (line 4 through Ifne 6) (7)
Total vatue (Ilna 9 plla line � (8)
1 hereby rertiy the above is true, cortect, Sigrewre o(PSSessor Date signed (mon1A, day, year)
and complete. �
Veitying attion - SigraW fe of Puditw Date signed (monN. day, yea�
� . - � � � • •
20 pay 20 _ Lesser of 60% of the assessed value af lhe homestead or 545,000 -
Nolwilhsfandirg any oM¢rpmvision, Ne sum a! the dedurliv�s proritled in IC 8-1.1-17 fo a mob�e home Maf is $
rwt assessed as reel property orlo a menNaUured home that is not assessed es iael pmparty may not erceed
one-hatl (7R) o! Ne assessed vzlue o! (he mobde Aome or manu7actu2d home.
SignaWre of Auditor Date signed (rtronN, day, yEa�