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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
S _ State Form 5473 (R1216 -09) r
°k Prescribed by the Department of Loral Government France
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
T7 T T T1
I/CERTIFICATION STATEMENT
I (We) certify that I (we) occupied as my (our) principal
place of residence or am a e) buying the following described real property for which a Homestead Property Tax Stand u on i eaay claimed
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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 to the trust or the right to occupy the property under the terms of a qualified pe s d
I R
INFORMATION,
Nam to )
Social Security
Social Security number of claimant's spouse (last five digits) Drivers ficernse I Identification I Other number Issuing Sea
of claimant's spouse (last five dgia)
CONTRACT ••. .
If buying on contract, Fee Simple owner's name
Recerdefs office where contract is recorded Record number Page
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PROPERTY DESCRIPTION
minty
Township
Taring district (city, town, tow ,
P rcel nu r
GJ �OttdO
legal d`�escr/ip'�tio�n
S (0(7 W
Is the pro m question:
Real property ❑ Annually assessed mobile frame (IC 61. f -7)
any portion of the residential strucNre or the land not exceeding one (1) acre that immediacy surrounds that structure is used to produce income, describe the use and portion
fIf
of the property utilized to produce income.
PROPERTY
County Township County Township
1 hereby certify the above statements are true, correct and complete.
SiaAaare o tai
/�V'
address (number anti street, cry, sate, no ZIPCadp],��
n 6�i 5 Cc ?? 1.4
t
ASSESSOR USE ONLY TRUE TAX V�LUE
Land not exceeding 1 (one) acre immediately 1 sF�4_i1E,•y,s�3s f $?`_•,
surrounding residential tm rovements. O "•- :.h += + +`%�+��tr »•� >'• -g`=
Other land
( 2 )
y <. =•
Total land (line 1 plus line 2)
(3)
55
Residential improvements or Annually
Dwellun g
4
()
Garage
(5)
Assessed Mobile l Manufactured Hom
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Dam signed (month, day, year)
STANDARD DEDUCTION ALLOWANCE.
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000
NotvifhslaM4g any otherprovis an. the sum of the deductions provided in IC 61.1 -12 to a mobile home that is
5
not assessed as real property or to a manufactured home that is rot assessed as real pmperry may net exceed
one -half ( ) of Me assessed Val olthemoblehomeormanulacturedhome.
for
Data (.� Y. resA