Homestead_Martin (5)11
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 / 609)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for frM instructions.
FORM YEAR
HC10
CERTIFICATION STATEMENT
I (we) 4'
certify H4`Il`vG)r as my (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard D u on is hereby claimed
under contract on the date this application is filed, (date of filing):
C.13 -nn' Y1-
�e) own ❑ Am (are) buying under recorded contract
jY
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
OIBSON COUNTY AUDITOR
AAUOF\
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence cost
INFORMATION
Name of claimant (legal name)
f�X�/rV
Social Seamy mrrbef at
Name of da nYS spotty (legal
Social Seamy numbet of claimant's space (last rite dgts)
If buying on contract Fee Simple owners name
Recorders office where contract is recorded
Rand number
Page
PROPERTY DESCRIPTION
Crony
Township
Tax rg d . to
ip)
Parcel number -
L al desorption
Is property in question:
—
Ml property ❑ Annually assessed mobile home (IC 61.1 -7)
If any portion of the residential structure or the land Aot exceeding one (1) acre that immediately suWullds that structure is used to produce Income, describe the use and portion
of the property utilized to produce income.
a &,2_0-1s -,e0 C6a 071 -001
PROPERTY OWNED BY
County Township County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
-
ress (number and street, city state, and LD e) D
l-6
ASSESSOR USE ONLY
HOMESTEAD NON-RESIDENTIA
I AT 100% OF TTV
I VALUE VALUE
Land not exceeding t (one) acre immediately
surrounding residential improvements.
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Garage
(5)
„a
Fr-ie .:
Assessed Mobile I Manufactured Home
Other improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is W e, correct,
Ass es
Signature of ess
Date signed (month, day, year)
and complete. '
Verifying action - Signature of Auditor
Date signed (nronth, day, year)
STANDARD r r
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any other provision, the sum of the deductions provided N IC 61.1 -12 m a mobfle home that is
$
not assessed as real property w to a memdactumd home Hats not assessed as reel property may not exceed
on"if (1/2) of the assessed value of the mob2e home or manufactured home.
Signature of Auddor
Date signed (month. day, year)