Homestead_Collins (3) :s.::; CLAIM FOR HOMESTEAD PROPERTY TAX F I -� FORM R
:v'j STANDARD /SUPPLEMENTAL DEDUCTION
'"may.;'-v- State Form 5473(R13/12-09) HC10 �y / rj
' Prescribed by the Department of Local Government Finance 2014 �./
APR 0 9 ` Q • 677 a/ _
INSTRUCTIONS:See reverse side for filing instructions. 7 //�r i • }}
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i, y, ,w�, �ti�45�5)yR�y "f— yyCERTIFICATION;STATEMENTJ " yrn•� Eu�'.'��n4�r't..
I(We) / I Mr1 /__■ - raillORte)occupied as my(our)prindpal
place of residence or am(_Vie)buying the following described real property for wh omestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We):
03Own ❑ 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.
, `-
If buying on contract Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
;�-••tr- ,+1^y'(s,..._C-,:,.A f2;aa ak:ti ilagAtrA P,f,ERT;V DESGRIP.T 61174- lati1. l.-aa'.' 2 T.ro` 0•r'2"`�r'.v+�y ie t
County Township Taxing district(city,town, urn-ship) _/1
��(c Ly(J A .LUe4
Parcel number Legal description I Is the 04361 property in question:
a (n -t7 5 - 5 k -o a. 5 - 000 . / It -0/ Fr property ❑ Annually assessed mobile home(1C 61.1-7)
If any portion of 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 property utilized to produce Income.
r--
i '�g� •x `i,{ 41110.RORERTT ezOWNEDAY C! AN fiiN;OTHER COUNTIES agS.V. .,S;£<_ * .,e_?2 M '4
County Township County Township
I hereby certify the above statements are true,correct and///c111omplete. Sg�hir of i/-/1
Address((3(number and street,ary,state, ZIP code) �r,�.0 7` 76,6 it
^= 'i..s�"+S"a4."n'f�%'�'a . :-a r'<•�`+'•?:"� sr+'-". N'xT"ig -- '`'ASSESSED VALUE' '�HOMESTEADT fi' ri NON"RESIDENTIArt J.
K�� ''+�z-' •� ASSESSOR USE.ONLYr 'yr�F-'�`'F 'k.`3I RUEaTAX:VALUE iwAT2•- ?i4 .. .-,VAL'UE c r
^~<S`�.�.. ri„5.s.E .�u._...r.piLy rture`d.2' t∎`FAT 00°/a,OFaTTV ,kVALUE` �" 2ii _.
Land not exceeding 1(one)acre immediately ? r - -
surrounding residential Improvements. (1) _-� ,..-i _3,£"-
Other land (2) = _• r
Total land(line 1 plus line 2) (3)
Dwelling (4)
Residential Improvements or Annually ,
Assessed Mobile t Manufactured Home Garage (5) (`(\ f .. moo S ." '.
Other Improvements (6) 1
Total improvements(line 4 through line 6) (7) t-11 aO 75 '
Total value (fine 3 plus line 7) (8) '
Signature of Date signed(month,day,year)
I hereby certify the above is true,correct
and complete. - -
Verifying action-Signature of Auditor Date signed(month,day,year)
E, *Alt l. `�"LSg h•!irat- TANDARfI DEDUCTION 6Z000WANCE + •.:kka _ir e-aelirti
20 /'y 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 real property or to a manufactured home that is not assessed as real property may not exceed
one-half(1R)of the assessed value of the mobile home or manufactured home.
Signature of tzs . O SmrtT / Date signed(month, ay,year)9-iii