Homestead_Straw = CLAIM FOR HOMESTEAD PROPERTY TAX Fob YEAR
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STANDARD /SUPPLEMENTAL DEDUCTION HC10
,f,`' State Form 5473(R13/12-09)
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Prescribed by the Department of Local Government Finance Q q
INSTRUCTIONS:See reverse side for filing instructions. V 162- 14 Q q/�— 19/ 2
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•� - '�'"1 vc ��-� v CERTIF,ICATIONrSTATEMENT�{��',�rJ�'FH - '. cys.�c' � •" t �'
I(We) (. ! 017)�r+ / c > Yfn''� certify t (we occupied as my(our)principal
place of residence or am(buying the following described real property for which a Homestead Property Ta n rdJedu s claimed
under contract on the date rs application is filed, (date of filing). I(We): y
own ❑ Am(are)buying under recorded contract
O Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation AUG 1 a 2014
❑ 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.
r { a - ' V.V' q ;3M u .`; +i• ANT'S ItJFORMATIONr t f - + 1u - ,- -E; tC+t
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Recorder's office where contract is recorded Record number Page
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litir _ OPERTDEYSCRIPN " iWiliS, RWRVA• 2 rw
County Township
Taring district(city town,township) 4 /
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Parcel number Legal description I Is party in question:
eel property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)eat that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
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� "��,,.�,� � .:�y,�_.`���•�"_„�tPROPERT,Y�OWND�BY�CLPIMANT IN=OTHER:000NTIES�'�.�,� .y`�at��gs..ti. ;<, �.;4>.�,i•..,�•t"•caz�w-
County Township County • Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
Address umber and soee(,p ,stat,and Z I P code) g� TO 1. �1 1, ati ,17G 33
c -i�'tsx fi,Faa '7Fi ro:m ` > 7,14:7ASSESSED ALJE,I: MESTEAD 1 � ,d'�y`NON RESIDENTIALf- - ,•' +2g'4IAS jcSSORRyUSE O YY� -+F`= =-.�t$'^I TRUE TA%IVAL'U IyAT 100%,OFsT:T,V'rdigzh3LVALl1Esm b i siti,VALuE ere - i��`.i
Land not exceeding l(one)acre immediately (1) ,CF K _.. _• _• -
surrounding residential Improvements.
Other land (2) "%�'
Total land(line 1 plus line 2) (3)
Dwelling (4) i f 3/tt .J? k;
Residential improvements or Annually
Assessed Mobile I Manufactured Home Garage (5) 0-:: r . .c.
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Other improvements (6) T r-
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
Signature of Assessor 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)
-"ta33e-%"r..�:rai atifITO;+��.s�-�":41.1iT4ISTANDARDPEDUCTION'AtiLOWANCE M„S ga`11V.,.MI',:eW,442_` .n. _ : _.
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 to a 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)