Homestead_Gayso f•;,, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
A.,, STANDARD/SUPPLEMENTAL DEDUCTION FORM
{ -1 Stab Fam 5473 0117 I 1-16) HCIO
!� Rasaied Mae Depaawa of Lard Gweraea Roams
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INSTRUCTIONS:See mem,side balm vuau7rora. /
NOTE:Telephone,Sods SeaWrx diver's icerm.state 6ferd<Swtn and federal idea:Iran numbers am cnfderdial under IC 6-1. 72:7.1 ,
. _ CERTIFICATION STATEMENT
I(We) _al I' AO 4 Li/ -i dr_ 0 • 41 oert fy that l(we)Ocaipl¢d as (Wr)Pnnd•' ;4
place of residence•�- (are)buying the following described real property under contract for which a Homestead PI 1Sfarldard
ris he=•-claimed on the date this application is signed, (date of signature). I Mai ?Q j/
❑ Am(are)buying under recorded contract
re) emitted to seamy as a tenant-stockholder of a cooperative housing corporation. G/QS ''-
o Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified Yerni-e:
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. Q +�Nt �••
YAt
Carey ToensM1y '�+��]///'/�/
Pace Rather 1 / //a, -r�s/s ) ;gab FR•avc V
re XI
7.-0/„./7 ain na ❑Msc'dymessed mcWStsms(IC6.Ih1)
a- - .. d Oti renders dmare a ae laded ((emostres ens(1)amaaat- aroma and to produce h-ama denote the=se ad Canon
dry//, - utTredbpodrebcom
a?4//T07_ad6-60o• 542-Qa7
- - -_-1(iii , ,-t-PROPERTRewiNED ELSELVHERE,EIT,C LA IMANT : 1r* r
Sao,Casa,and Twra,ip Is claimant vacating a homestead?
❑ Yes ❑ No
��ggq���ss�ae d r
hereby certify the above statements are true,coned,and complete. ^( . / / i ,
Address of canna(numbers/xi salsa db;a de,and Wont) - Address of vacated lnne9md,d any panderfsl. ay. . .end ZPPcde)•
�5 r3- w 3K Co c,nc 47c,
ASSESSOR USE ONLY J _ ;• I ASSESSED VALUE iJr..-
.HOMESTEAD VALUE- _I .ry NON-RESIDENTIAL r[ ?
Land not exceeding one(1)acre immediately s r.-z- %r
1 '
surrourdvg msdentW improvements 0) > :s .2' 1-<"
Oer land [`-O?vy..
m
Total land pine f plus rare 2) (3)
Residential Improvements or Dwelling (4) s S
yx
annually assessed mobile l
manufactured home Garage (5) .y,.-_.-__ .. .-.x'.ev: .
r ' r s; tOster im provements (6) orn tt -,3:r ice'__.-:y
Total Improvements(line 4 through line 6) (7)
Total value pine 3 phs line 7) (6)
I hereby certify the above is true,correct, SAUessdr s�se.1(moreq a51:Yet)
h
and complete.
VerdyYg=bon-Sipe ate a&kd,•a Dab signed Waal;day.ref)
20 pay 20_ Lesser of 60%of the assessed vdue of the homestead a'$45,000.
NoMsifhs4rffig any other provision,the sum of the deductions provided in(C 6-1.1-1210 a mobile home $
(hark not assessed as real 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 hone.
Sig rare dAa tax Date dente(m0NR day.Yaw)
NSTF®UTION:Ddgid-Carey killer.FieDznwed Copy-Taxpya-
Page 1 of 2
a
°'" CLAIM FOR HOMESTEAD PROPERTY TAX �'
=e_. STANDARD I SUPPLEMENTAL DEDUCTION HC10
lt.' State Form 5473(R13/12-09) • --
�O ,,, ? Prescribed by the Department of Local Government Finance I 20
INSTRUCTIONS:See reverse side for filing instructions. , 4
_� \ Xi .,n - - CERTIFICATIONNSaTATEMENT ., 'i-
I(INe) ruff?LAW_/IraAt/�r t 7L Li I� - certify tha •weloccupie. as my ,1 1 Tnli R I
place of residence or am(are)buying the following described real property for whiapi'a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, ` - tate 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 member of the entity that owns the property.
_
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Township
I Ad
Parcel number � e o Is the p operty in question:
{{{{j� !/ p2/j Real property ❑ Annually assessed mobile home(IC 61.1-7)
If any porti4 9 the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income.describe the use and portion
of the pro utilized to produce income.
of -//-62-0700 _OOO. Vat'?-dell
._._.__ _.. _...v . ... ....
.
- - .:"s PROPERTYOWNED BYCLAIMANT IN OTHER-COUNTIES, _ .::._ _ - .
County Township County Township
Signature
I hereby certify the above statements are true,correct and complete. %4'�
Addre�number and street,city,state,and ZIP code) / AKA ' ci e?r3
ASSESSOR USE ONLY ..• I. E TAX�VALUE I AAT E00%OF TTVE I _HOVALUEAD I NON-VALUENTIAL __.e
Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line Z) (3)
Dwelling (4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
I and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
•
' - STANDARD DEDUCTION ALLOWANCE - ,
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 6-1.1-12 to a mobile home that is $
not assessed as mat property or to a manufactured home that is not assessed as mat properly may not exceed
one-hall(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)