Homestead_Ricker CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
d
:A I STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sate Form 5473(R15/S14) HC70
1. Prescribed by the Department of Local Govern rent Finance
iett.INSTRUCTIONS:See reverse side for tang instructions. /
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1 i-1 -371 l t
EAV ,-;_jam I' �/—�._._ 44! CERTIFICATION STw FMENT' 2 '-
I(We) /f'///y(�`a/�� e Ai�// _ -..." certify that I(we)occupied as m (our)p .•1111
place of re idence or am(are)•��•the following de led real property under contract for which a Homestead Prop x tandard
Deduction is hereby claimed o e date this applicati.� signed, (date of signature).
Own. ❑ Am(are)buying under recorded contract. 2�/rl
. Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. (�`/ec
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pe .kr�s�
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. UNr y
-'c.. it ..:-_-7::: C, i .14—rLCLAIMANT•S INFORMATION:"r:= ..°'•L" x-- - '=f8!1r OR
Recorder's oice where contract is recorded Retard number Page
F t S- :__X - '^ PROPERTY.DESCRIPTIONij^^s'.±2'? T$y' - .
Coon. — _ °__ _ _
/ II I rf/S/ — 1 /�
Pa.cel numbs A ., ,.,_ _eel lxope ❑Annva mobierome(IC 61.1-7)
If any pardon of the residential sascmne or the land not exceeding one(1)acre that immediately su .s that Rrudure is used to produce i oom describe the use and potion
of the properly utilized to produce income.
07‘.-- /7 /a2/arO - 00/ 1?/- 002-/
PROPERTY OWNED ELSEWHERE BY CLAMANT .
Stye,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
sig • d' arrant ��
I hereby certify the above statements are true,correct,and complete.
Address of=react(number and stree/ray.state,end LP code) I o vacated h . tead,d any(number and street.of%Rate,end ZIP code)
SO W rsCO S C rvJeaSv I lea) N iv&& ca
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON�ESISIDENT1AL
Land not exceeding one(1)acre Immediately I(1)
surrounding residential improvements
Other land 1(2)
Total land(line 1 plus line 2) I(3)
a Residential Improvements or Dwelling I(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) (8)
I hereby certify the above is true,correct. Signature of Assessor De's signed(met*clay,yeah
and complete.
Veiyig adM-Signature ofAUl-tot Date signed(mon*day.yea)
' - + - "STANDARD DEDUCTION ALLOWANCE ` ` a 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 to a manufactured home that is not assessed as real property may
not exceed one-halt(12)of the assessed value of the mobile home or manufactured home.
Sgnaeae of Auditor Date signed lifer'•..\day.Man
DISTRIBUTION: Original-County Auditor.ReSamped Copy-Taxpayer