Tenbarge a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,
��-' STANDARD/SUPPLEMENTAL DEDUCTION FORM
KsState Form 5473(R13/12-09) ;- HCIO
'7- _State
by the Department of Local Government Finance i
INSTRUCTIONS:See reverse side for filing instructions.
,:iz_ill;tii` k4f.?r`'' _-r:s.+ .:..•(eA 'r'l3,•?Mgt Pktf -ile RTIF;ICATION;STATEMENT'}J iws •.'svmtit.9ca-i`i:[ariir'4 h'r $. i. r-,tv-
I(We) I. • . `l A. - I f r certify that I(we)occupied as my(our)principal
olace of residence or a - buying the of owing described real property for ich a Homestead Property Tax Standard Deduction is hereby claimed
/ Mier contract on the d- s application is filed, (date of filing). I(We):
Own ❑ Am(are)buying under recorded contract
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner or memberm of the entity that owns the property.
`'= mx31 %�i?f-L` 'l`S`ktk, .r>- -<6.. aR3-15-}=r .CITAIMANT'SIIN,ORMATIONI _.:11—%L?�b`v!icry Osriv^.eL i',--'.x`.5.`.;1.�.--z: «iota
Name of claimant(legal name) 1 I
Social d last fiim Driver's license/Identification/Other number
p ,/ / Issuing State A i
x =to Fi„j 7 Ol Velmam(last five diets) ' 1 —1 I - vJ i Y 1
Name of claimant's spouse(legal n k l. ) s0.
Sadd :-iN number of claimant s tiltit rive digits) Drivers license/Identification/Other number I Issuing State Al.i of claimant's spouse(last five digits) 7". 1 CI-
9/2c 1 J
[ 1 lUL7 l
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
r t. 9k U s .`,xf,:'.hr r.Txsttic,: rxt`: -.5w,f . iPROFERTY DESCF2 .:T(ON'.1:,-,;Z ' 'EN( vd .. .-„i'Yi .- 4 13'. ;=iti:In
County Township Taxing dd(city,town,township)
Parcel number Legal description Is the property in question: j--
❑Real property gJ(/krvtua%assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is use4ttoproduce income,describe the use and portion
othee property utifaed to produce Income.
• a � . 9 zb — Q� aU - Oa
v_ :"fit-i$ i- l).s ja? raFf:kPROPERT.Y OWNED BY_CLAIMANFIN OTHER'COUNTIECI,t rip S&.4.yZ,Uq-;.t;;.h_. ire- . _=I?
County Township County Township
I hereby certify the above statements are true,correct and complete. Sigra claimant ;\ , /) N�
Add,...(number and street,city state.and ZIP code) /l C/ X//
_ t ASSESSOR USEONF*Tgkli yi�';IfyTRUEyTAX VALUE I AT.I100 E OFT.TVs�,tk.SVAL•UEAD 4lr.0 i�N VAL' SC1.1i L - c
rand not exceeding 1(one)acre Immediately rticp-.iret:1. 4,1- , .'
surrounding residential improvements. (1) i.57.r 'r=" 4as`7`Y'- ,:„.
1`...d5-.''
Other land (2) Ale. ,F41:J
Total land(line 1 plus line 2) (3)
Dwelling (4)
Residential improvements or Annually � ,.ye�.,, -pg
Assessed Mobile I Manufactured Home i Garage +;e i-r •r'P4 $'
Other improvements (6) ,+_^r4r 4.-l'i,.' '' ".
Total improvements(line 4 through line 6) (7)
Total value (line 3 pea line 7) •
(B)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete. \�ti1 )
Verifying action-Signature of Auditor y• ra . 6 k4 Date signed(month,day,}roar)
$Pz 9 `aa- r r i• A-151,'%STANDARQOEDUCTION;ALLOWANCE ,i `7 tit a+ rC : c-cry?; sr t> +
--. - 2 __.... .., as'„avt''G. �.,...rv,o.�S�T iv`1en,1t. .. _.. __.-.._ " .- __-. 0.-.;;yC'- , �v.�-..:.-,17.9 �.�^. si�w-ir. _ aS_
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 IC bit.1-12 to a mobile home that is $
not assessed as met 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.
Signature of Auditor 1 Date signed(month,day,year)