Homestead_Garrett (12) .p.._ ` CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
- STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Fonn 5473(R15/5-14) HC70
Prescribed by the Department of Local Government Finance s(
INSTRUCTIONS:See reverse side for filing instructions. t ,
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NOTE:Telephone, Sewdty,d' :es license,site Identification:111 federal identification numbers am confidential under IC 6-1.1-12-37. '
"—.•,T!T"' ' /�'-�:itch a.:a�1:, ,nCERT.FI ATIONSTATEMENTL C a'?-T , 'cifi• 1 '.r'9➢.-:C.
I(We) �W?1!SVJ���VA1]! "..certify that I(we)occupied a WI v t DLL.Eui iiu
place of residence-ram(are) ing the allowing described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed o• •�e date this application is signed, (date of signet ' . I(We)�
❑ Own. ❑ Am(are)buying under recorded contract GIBS / e-1�A
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
ON COUNTY AUDITOR
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
.•;
e� g CLAIM FOR HOMESTEAD PROPERTY TAX
;��� CREDIT/STANDARD DEDUCTION
_�` �� State Portn 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lo� /iling inshuctions.
our principal place of
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a� � ,
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NOV 07 1996
certify t����.lcWay of M�h. 79_
V I'S
described real pmperty for which.a�HOmesiead Property Tax Credii is hereby daimed:
� I(We) owned ❑ Are buying under coniract -
❑ Have a beneticial interest in the entity that is liable for the property taxes on the property and ihat owns the property or is buying under a contraci. �
' � � - � � CONTRACT RECORDED:- - � ' � - � �
If buying on conhact, Fee Simple owner's name� -
Recorder's oflice where contract is recorded Record number Page
�- ' � � " � � - " � - � PROPERTY DESCRIPTION' � � - - �
Counry � Township . Ta<ing distnct (city, towq (ownship) _
Parcel numbe Legal description
U5-�3$�7-c_m �
If any ponion of the residential stmcwre or the land not exceeding one (1) acre t�at immediatety surrounds Ihat structure is used to produce income, tlescri6e the use antl portion
ot the pmperry utilizetl ro protluce income. . _
- / - �lJ -UO - QoL
�� � _- PROPERTY OWNED BY Cl.A1MANT W-0THER COUNTIES' � �
Counry Township Coumy � Township
�eby certify the above siatements are true, correct and complete. siqn e of ci imant �
Address (numberandstreet ciry, s(ate. ZlPcode)
' ASSESSOR USE ONLY TRUE TAX � ASSESSED . HOMESTEAD� NON-RESIDENTIAL
_ . VALUE VALUE. VALUE VALUE
Land not exceeding 1(one) acre immediately
surmunding resideniial improvementa ��) �
Otherland (z)
Total land (line 1 plus line �. (3� .
� . Dwelling (4) - �
Residential improvements
� Garage (g) ' .
Oiher improvements (6)
Total improvements (line 4 through lina � � (7�
Total value (line 3 pUs line � (g)
I hereby certify the above is irue, cArreCi, and Signature of Assessor - Date signed
complete.
'�°ying action - Sgnanre of Audiror � Date signetl
19_Pay19_
Lesser of 1l2 Homestead
Valuation or 52,000
STANDARD DEDUCTION AILOWANCE -
S
signed� _ �/ I
� � S�
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