Homestead_Hoke t'°4>.v CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
.y STANDARD /SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R13/12-09) HC10
�;u„I Prescribed by the Department of Loral Government Finance f t.'
INSTRUCTIONS:See reverse side for filing instructions. B la (96. / gat,
I CERTIFICATION a o J
I(We) . _41A4 f i 4%1 kJ -.n-7.:'_v--- i L certify that I(we)occupied as m (our)principal
place of residence or am(are)buying the following described real property for which a Homestead Prope S n rd D u kJ; 4 reby claimed
under contract on the date this application is filed, (date of filing). I(We):
❑ Own ❑ Am(are)buying under recorded contract
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation NOV 7 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. L12frillr
- . INFORMATION
o CONTRACT RECORDED '
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION'. ° I
County Township Taxing district(city,town,township)
0-_Parcel number Legal description Is the property in question:
6' IO. 0'1-40q. toa.-Lita:Oa& ❑Real property ❑ Annually assessed mobile home(IC61.1-7)
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.
,a _ . PROPERTY OWNED I37 (,I OTHER COUNTIES ° o I
County Township County Township
I hereby certify the above statements are true,correct and complete. I Si nature claimant
Addr (number and street,city,state,and ZIP code)
/2-7— 5 - SitolerYlo -Sr CLdCe7on) l� 476 740
ASSESSOR EMG a sn UMVALUE ASSESSED VALUE I HOMESTEAD NON-RESIDENTIAL
TUi / of nR •T . T
Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Annually Dwelling (4)
Assessed Mobile/Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plta line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day,year)
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 mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
i