Homestead_CoomerRI
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 /6-09)
° Prescnbed by the Department of Loral Government Finance \\
INSTRUCTIONS: See reverse side for riling instructions-
e
( i Roil
APR 3 0 201U
I (We) QA4
pied as my (our) principal
place of residence or am ( r) buying the following described real property for which a Homest 00I4?i1d "D1JWfton is hereby claimed
ntract on the date this application is filed, (date o1 filing):
e) own ❑ Am (are) buying under recorded contract
r
(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
I
CLAIMANT'S INFORMATION,
Name of t (legal name)
ell
Social Secrrnty, number of da'unant's spouse (last five digits) Drivels license I Identification / Other number
Issuing State
of claimant's spouse (last fire digits)
CONTRACT ••r r
If buying on cim ad, Fee Simple owner's name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County Township Taxing district (city, town, township)
Parcel
number Legal desenplfon
Is the property in question:
()6�39L—Ibb�
1:1 Real property ❑ Annually asmsimd mobile home (IC 6-1.1 -7)
any portion of Ne residential sWdure or he land not exceeding one (1) acre that immediately surrounds that structure
is used to produce inborn, describe the use and portion
®If
of the prepeM utilized to produce income.
Pt Nw Sw do a -4
„
• M s ►ac,.
PROPERTY OWNED 13Y
County Township County
Township
I hereby certify the above statements are We, correct and complete.
term of I
Add ss numberandsimet oly,state, and ZIPoode)
ASSESSED ASSESSOR USE . ONLY TRUE TAX VALUE VALUE I
AT 100% OF TTV I
HOMESTEAD NON-RESIDENTIA
VALUE VALUE
Land not exceeding 1 (one) acre immediatelya
(1)
-''
ht"
surrounding residential improvements.
�'�^'�'•` -- '� r,:.a -s�
Other land
(2)
n pk,,
Total land (line 1 plus line 2)
(3)
r0
Residential Improvements or Annualty
Dwelling
(4)
-., st37• wtt' :.
Garage
�y �>3�,t, ice`aY'✓ fp
Assessed Mobile I Manufactured Home
(5)
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
Oae signed (month, day, year)
and complete.
Verifying aeon - Signature of Auditor
Date signed (month, day, year)
Md
STANDARD DEDUCTION
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
-
Ndw4hstadlrg any wherprovision, the sum of the dedectionc provided in IC 6.1.1 -12 to a mobile home Nat is
S
not assessed as real property or to a manufactured home that is not assessed as real property may nor exceed
one- haH(1)2) of Me assessed value of the mobile home or manufactured home.
Signature of Auditor
Data signed (month. day. year)