Homestead_Powell"
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
i, --
.its Ilene
of residence or am (are) buying the following described real property for which a Homestead Property Tax St���a d'Db
State Form 5473 (R1216-09)
,a
Prescribed by the Department of Local Government Finance
INSTRUCTIONS., See reverse side for filing instructions.
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JUL 1 4 2010
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I (We) certify that II(q(we nN etl�aNmYy ( LoprTpRal
(LR111LIn
.its Ilene
of residence or am (are) buying the following described real property for which a Homestead Property Tax St���a d'Db
yQlXaimhed
place
under contract on the date this 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
INFORMATION
Name imam (legal name
Sodal
aV/
,Name of claimant's spouse (legainame)
Social Security number of claimant's spouse (lasf rive dgds) Drivers license I Identification I Other number Issuirg State
of claimant's spouse (last five digs)
CONTRACT ••s r
11 buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County —,
Township
Taring tisilict (city, town, township) '
Parcel number
d'e'scription ', .O 7 [
Is the in question:
rl
N A) 3 a 39
7p�roperty
P.rseal Property ❑ Annually assessed mobile home (IC 51.1 -7)
portion of the residential structure or the [arid not exceeding one (1) acre that immediately surrounds that sbuc h, is used o produce income, describe the use and portion
prop erty utilized to produce income.
kte
-/60- ool, ✓ol/ -oo i
PROPERTY r BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true, correct and complete.
Sig Pre of claimant
ress (number and street, tiry, state. 9, ZPON If
ASSESSED VAL
ASSESSOR USE ONCY. TRUE TAX VALUE AT 100% OF W71'
Land not exceeding 1 one acre immediate
9 (one) immediately
O `«'�•=
surrounding residentialimprovements. -•.'.. ��- i-- .'•'f`sx�
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwellin'S"'r"i`3
g
(4)
-•" : �,�. j7.rar .
}'
Residential Improvements or An
Aessed Mobile l Manufactured Home
ss
Garage
-��; -^�`�
(5)
f'? F 3a zf?�a�r.
Other improvements
(6)
Total Improvements (line 0 through line b)
(7)
Total value (line 3 pis line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Data signed (morph, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
_
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STANDARD DEDUCTION
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 51.1 -12 to a mobile home that is
$
net assessed as real property or to a manufactured home that is not assessed as real property may not exceed
ona -half (1/2) of the assessed value of me mobile home or manufactured home.
SignaWre of Auditor
Date signed (month, day, )eaj