Homestead_Gordon CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-r 1 t STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1515-14) HC10
I ' Prescribed by the Department of Local Government Finance '
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Scanty,driver's license,state identification and federal identification numbers are confidential under IC 6- _
CERTIFICATION STATEMENT •' -`' —" _ fi,�')= _:1(,_
I(We) , 0 �I certify that I(we)occupied y ., MK
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature).rl!41 5 n
❑ Own. ❑ Am(are)buying under recorded contract. llCl. Z}r�4
Y 9
❑ 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 r ncel �-�
❑ Am(are)the shareholder, parser, or member of the entity that owns the property.
s.'`_•. ..._ .
It buying on contact,Fee Simple owner's name
Recorders otsce where contract is recorded Record number I Page
Canty I Township I T - :C holy town,township)
1 Parcel number Legal description l PT Is the property in question:
!�// 024,-,.,- I ❑Real property ❑Annuaty assessed noble home(IC 6-1.1-7)
It any portion of the residential saumare or the land not exceedgg one((1)acre that immediately surrounds that etnfure is used to produce income,describe the use and portion
of the property ud¢ed to produce e,00me.
a&-/a_o 1 — ,Loa- 000. 980 -0 ?-8
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,Courey,and Township Is claimant vacating a homestead?
' ❑ Yes ❑ No
egn le of claimant e al d�
I hereby certify the above statements are true,coned,and complete.
f1' are.a d LP -) I Address of vacated homestead,d any(number and meet,opt state,and ZIP code)
/C �e19 (li _rid. ► VIC yi 70
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surroundinq residential Improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)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) (6)
I hereby certify the above is We,correct, I Signature of Assessor Date signed(month.day,year)
and complete.
Vedyug action-Signature of Arse for . Date signed(rnons;day.year) g�
�� 1 . N 1t,
r 1d ly
_ =' �.w -:= =:STANDARD DEDUCTION ALLOWANCE;i�-.his«= C 1h—i;.}�, i-
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545.000 ,I
Abtnithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ DEC 5 20 4
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(112)of the assessed value of the mobile home or manufactured home.
Sgnaae of' 'c 4 Date sines Inwt dyy)}'eeg
GIUSON COUNTY AUDITOR
DISTRIBUTION:Org'naI-Court,/Aud.tw,Fie-Samped Copy-Taxpayer