Homestead_Rostron (2) CLAIM FOR HOMESTEAD PROPERTY TAX _ '
' STANDARD/SUPPLEMENTAL DEDUCTION FORM YEAR 1,
3• State Form,5473 iR t>1 1-23', HC10 I I� �i .
P-esc-bed oy tee Cepa'•re^t o'L:_a 3:.e a -_
INSTRUCTIONS See reverse side for filing instruct ons
NOTE Telephone.Social Security drivers license state identification and federa,icenhhcabon numbers are confidential under IC 6-1 1-12-37.
CERTIFICATION STATEMENT
..
IiWe' �..Wgy�pp`4 r--- s ' t- (M-` AN'. .• —r occur-en as-, :pr:roipa place of
resde'cee. - ,ae.c..l- e _ :.)r'e_ -_ --• e- : -- - .. , : _ she y c'a—ed cn nee
date the app'.'eatrcr s s geed -_. _ - __ 3 . - ..
ID AT{are,ert,tred to occupy as a to^a^-st;-:-.-or Cu:--=-al.e c-s rug c^ccrat a •
❑Ha.e a neefc,a,.r.te'est Ir the trust or ire non:to occupy ire p"ope-7 _ :_ - - . -.... ___- -•
0Am are,the shareholder pa'-a' or me-oe-of e e-'-.--a:::.-s --_-__-_-'.
i'1 Buying or Contact Fee S:rep-e Owners Name
Reco•der s Off.ce flee Ccrtrac:s Recorded • -
a PROPERTY DESCRIPTION
•
=arce'.umoe•
�JJ Rea.o.cae-1y 0'r-_a,1 Assessed':ccwe f..or:e,CC-'t''. '
I'any eon:or cf ire res'dert,a'str:ct,.•e or the'3.--, e•:e=_ - - ' --- .. _-r'=•'- '-at sr'„cf.re s..sed to orcduce.^.come describe the use and port or
of the properly.it zed to produce rcome
Ct -- 3 \ 3�— c�o0 ,3;� --off?- 6.' l 3
1
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County and Township -- + _..:
•
I hereby certify the above statements are true correct and complete /' L R
Aod es�:_^'act ^..mbe•3^d i"ee' a°, s•e•e a-'=:-._ _ _ es -r�es'e3] 'al, .'burner and st-ete or-yr stare and Z.°c^.^=
ar-
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately I(1)
Surrounding Residential Improvement I
Other Land 2 — —
Total Land(line 1 plus line 2) 13.
L
Residential Improvementssedor Dwelling 41 V�
Annually Assessed Mobile I
Manufactured Home Garage ' S; i1 n
,41)
' Other Improvements 6; Q[�
Total Improvements(Line 0 through Line 61 Qi94 t/ �O?A
Total Value(Line 3 plus Line 7) - NCO`F�JA/
''IICI
_ _ _.`-ssessr ate Signed Mare --r-V�S'�'Y�
I hereby certify the above is true,correct,and complete. '9(7O-'Fc
—
Vechyrg action-_g-3• - _-• -Clare S,gred d3fe r , TOR 1
STANDARD DEDUCTION ALLOWANCE T
2^ Pay 23 Lesser of 5C of the assessed dar-e 1 homestead sot.
NOt.uthstar,r;3-,Ot^E'or:, me s.. .:r' _.._- _ .,rs_ -. - '2 -3 :C _ - =.'a' S
5 not aSOeSOe:ar, -_ _ -y _ _-..., _ .• _ -ed 33'ra maceny-3/-:'
erceed one--a` . _ - - .- _ - me
S,grature of?utlaor , m'r o,
_— ..ate g d a 1-_.
DISTRIBUTION Cr;lra1-2 c.^:,-..•_ = _ 1—,:..— -.2,. -3.cayer `
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