Homestead_Kenworthy (2) n• CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/ SUPPLEMENTAL DEDUCTION FORM YEAR
i• State Form 5473(R13/12-09) HC10
\-; ' Presaibed by the Department of Loral Government Finance
-'_,:. - 'CERTIFICATION STATEMENT .
I(We) • - IFAI i -- certify ` ( �') PI•1• -- 1 h)principal
:.
place of residence or am(are)buyin. the following described real �oerty for which a Homestead Property T- to - •as:.. .. i ;-'.y claimed
under contract on the date this application is filed, _(date of filing). I(We):
❑ Own ❑ Am(are)buying under recorded contract FEB 6 2014
❑ 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 perso•iY ; id-.,r •!
❑ Am (are)the,shareholder, partner or member of the entity that owns the property. v�'>f1/�'
GIBBON CO [. • r
n z it-�.,.-.. ,..,. .e ,,r
_ .,.-#;,��. r x=. .� -.. - '°«'`;��C_LAIMANTiSINFORMATION_r„i�._..,.,: -:� >:4_� ��Y-->si. :�.�4�
-_ ,.:. _- _:,If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
_. - - P,ROFIERTY,DESCRIPTION,,, ' _ - -
County Township Taxing district,,town,township)
Parcel number Legal description Is the property in question:
•
- - '1.601 R ''11 S ❑Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
rz4, — i/ - /a — 7-613 - 00 3 -: a-,s,4 - oc2_8
- _ .PROPERTYfkOWNED.BYCLAIMANT IN OTHER COUNTIES ,,
County Township County Township -.
I hereby certify the above statements are true,correct and complete. Sig•. a∎nt 1/ `
Address(number andatreet,city,state,a•.21P cod
X e)
/ a 0 I - - (A ce/0.0 „1,---71,.. i (IA- 2 Gt:6e-1--- ' er----
'.- ` FASSESSEDVALUE HOMESTEAD NON-RESIDENTIAL '
ASSESSOR USE ONLY-. TRUE TAX VALUE -
- -- - - - .q.ATd 00°/:OF=TTV . ,.VALUE - -VALUE Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4)
Residential improvements or Annually _
Assessed Mobile/Manufactured Home Garage (5)
Other improvements (6)
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)
I and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
- - . STANDARD DEDUCTION ALLOWANCE . - - - - _
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 in/C 6-1.1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signatu of. Date signed(month,day,Year)