Homestead_Church �.�„: CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD /SUPPLEMENTAL DEDUCTION HC70
" State Form 5473(R73/12-09)
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prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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I_/ Q, M r• y_/f certify that I( ..pie, r h .pal
place of residence or am(are)buying following described real property for which a Homestead Property Tax Stan.. D sir ionnis e b i j ed
unde contract on the date this application is filed, (date of filing). I(We):
Ovrn ❑ Am(are)buying under recorded contract AUG 8 2014
❑ 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 resid ce trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property.„r.•-�i.. prope rty.
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If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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Township Taxing d' ( y ion,township)IP tZi. v - r� �vx/J L�"l/1Ci
Parcel number L al esaip' n /f Is the party in question:
/.n /r AiJ' Stc-a Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land dlr not exceeding one(1)acre that immediately ds that structure is used to produce income,describe the use and portion
of the property utilized to produce Income. O
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r.� .*%-v oraa PROPERTY OWNED:i8 CL!AI_ANT'HI R COUNTIES a tIll>_`T.'.4°'tg-s. 41X
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
ress(number end street,aty,state, ZIP N /A J105#a0f1t �A 476 39
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-"^ �'Y'•v`Y.-M —RrF trrir i ma_r l,'.Mp.- f (ASSESSED VALUE I;RHOMESTEAD i 1,.x, NON RESIDENTIALYC e„
-4•-.,.• ' r sS.§112FR5;1-1.ON Y ` r`��� TRUE TAX VALUE I ATa100°/OF TTV,rt'a.�,ee1VALUE+f%`s,�x Y'a VALUE "u- T > .
Land not exceeding 1(one)acre Immediately 1)
surrounding residential Improvements. (1)
Other land (2) - - -
Total land(line f plus line 2) (3)
Dwelling (4) Nt�
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sseResidential improvements or Annually —
Assessed Mobile/Manufactured Home `' r 't7 a ,3
Garage (5) .. <- ." .r. .- _� .- ..-o t:
-
Other improvements (6) - -
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (6)
Signature of Assessor Date signed(month,der year)I hereby certify the above is true,correct,
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
?':,.-s:ef q na v -•u °`` tW,,�+'tt-.ry.,,jSTAN D'AROIDE0UCTI0t∎I �OWANCC EZa,.. . ."lial aC Wiz` v'at„2XxaN.{;i;`.
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 toe mobile home that is $
not assessed as real property or toe manufactured home that is not assessed as real property may not exceed
one-halt(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
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