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Homestead_Lienemann Z."'>.v CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR• >a.-- 1 STANDARD /SUPPLEMENTAL DEDUCTION HC10 State Form 5473(R13/12-09) , ! Prescribed by the Department of Local Government Finance INSTRUCTIONS:See reverse side for filing instructions. n - -_-% _ -CErrRTIF:rATION STATEMENT - .• I(We) ,p a __/ ) fli 6 "9°YN certify ( .. pi •ur)principal place of residence or am(are)buying the following described real property for which a Homestead Property Taanr.i!s edu is l•y claimed under contract on the date this application is filed, (date of filing). I(We): ❑ Own ❑ Am(are)buying under recorded contract SEP 1 2 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 person- residence trust ❑ Am (are)the shareholder, partner or member of the entity that owns the property. • . SOW.: ' #_' - If buying on contract,Fee Simple owner's name Recorder's office where contract is recorded Record number I Page .1 . - 7.; -:V•. - - ` . . - - _ . tP-ROPERTY DE§CRIPTION'n -. :. - •' -:'.,., Cou / - Township Ta.ng dis •• ( " town,to rip) Parcel number � :,apl description I-the property• uestion: 01/1-3i-/°"' -iTO . 1 o 5- o� Real property nualy assessed mobile home(IC 6-1.1-7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately surro nds that structure is used to produce income,describe the use and portion of the property utilized to produce income. ..- kPROPERT1YiO•wNED,BYCLAIMANTIN-OTHER COUNTIES- _ . County I Township County Township .• I hereby certify the above statements are true,correct and complete. Signatvr claimant K ,,z�J�C(`Y'g%✓"'®-' cj Addres*(number and street,city,state,and ZIP code) \ l ) -IC �Y 0 I , , • - 9 ' l • —1 if ASSESSOR USE ONLY ♦ TRUE TAXVALUEaI ESSEti HOVALUE_D" I NON-VALUENTIAL Land not exceeding 1 (one)acre Immediately surrounding residential improvements. (1) Other land . (2) Total land(line 1 plus line 2) (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 plus 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 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 mob&home or manufactured home. Signature of Auditor Date signed(month,day,year)