Homestead_Larkins �fc _ CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
` STANDARD 1 SUPPLEMENTAL DEDUCTION HC10
I" State Form 5473(R13/12-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
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I(We) .)< tt _ n _.. `a.. A.—� • V_ ceNfy that we)occupy,. a ■ co nndpal
place of residence or am(are)buying the following described real .N.perty for which a Homestead Property Tax Standard Re`� 1 duc7uo4 is hereby claimed
under co don the date this application is filed, (date of filing). I(We): J uL + 2014
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 perQ) 0ip AUDITOR
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
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- . _, s.y*y;�>���$a�. r.�.a.1 CONTRACTiRECORDED;r'-�aac3`' _:nt...r_ �'a,.:.�"7�+'y.:'_--'X..t,.=.a�:+-t���€a:.-' =`c-3
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number Page
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County Township Ta�pnq district(dty,town,township)
Parcel number Legal description Is property in question:
L ?t-3a ,'4n3-1 co•Vas- obi eat property D Annually a. •sed mobie home(IC 6-1.1-7)
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. 4�
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County Township County Township
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I hereby certify the above statements are true,correct and complete. `-pi lure of claimant
Address(number and street city,state,and ZIP code) - ...
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s'i 'tt'`4•asr_Sr..'°O i'x-attlnix%1 'C -T"x7 ¢ ASSESSED VALUE:IreiHOMESTEAD'" r""r'NON RESIDENTIALfg rr'
'N., ' uASS E�lOR,USE!ON i v TRUE TAn:JAL+UI it�AT�100V0F.aT.T,V�:ftr' isxVADDEo �� -:r.�.3� °VALUE ' ,v,. ZE
FI li,,a, Br C
Land not exceeding 1(one)acre immediately (1)
surrounding residential Improvements. `
Other land (2)
Total land(line 1 plus fine 2) (3)
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Dwelling (4) ° i -f _.F a .cam_
Residential Improvements or Annually - : .,
Assessed Robber/Manufactured Home Garage (5) >; ' A' ---4.--_,-a.: 4 }r.
Other improvements (6) '":'`,..-C--'2 :74 ij
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
Signature of Assessor Date signed(month,day,year)
I hereby certify the above Is true,correct,
and complete.
Varying action-Signature of Auditor Date signed(month,day,year)
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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 real property or toe manufactured home that is not assessed as real property may not exceed - - - -
one-half(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
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