Homestead_McCarty (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
� ? STANDARD I SUPPLEMENTAL DEDUCTION
'I1�> State Form 5473(R15/5-14) HC10
�`• —/ Presmbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
place of residence or am(are)buying the following descri real property under contract for-1 ich a Home-'- • P l•p=j Tax �-n •ar I�!
Deduction is hereby claimed on the date this application i igned, (date! sign -
r
LSO Own. ❑ Am(are)buying under recorded contract.
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. DEC 1 1 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.
_, 'i,- '.CCAIMANT.'SINFORMATION -_" .'r-_ ;sss- -- N(f;
i. . 'T.' . . -E L`CONTRACT;RECORDED.."'.= '_<- Jl'----.,tili`
If drying on contract,Fee Simple owner's name
Recorder's office where contract is recorded (Record number 1 Page
County Township }+•T - stria( .y.Arm%msh )
Parcel number Legal C M ^ �. Is property in pues'.iort'
�r•1/ MD ///,..�1 Le/`XJ�J�/y(••/- >Ideal property ❑AmwN assessed mobie home pct 61.1-A
If any potion of the residential structure or the area not exceeding one(1)acre that immediately surrounds that Kructre is used to produce ihmne,desmbe the use and portion
of the pope try u!¢ed to produce vtcane.
R&,-/S-oh.- 4,1ao ax) ?1/457 do 9
PROPERTY OWNED ELSEWHERE BY CLAIMANT '
State,Cony,and Township /I Is claimant vacating a homestead?
A Yes ❑ No
I hereby certify the above statements are true,correct,and complete. X j/oIII'A"' I/ I A r�/ y/(
Add;:f contact Gum✓. •street,'/ .state,. ZIP code) trdd�•1 v tact hmievead, m(numcer and ncet state.and ZI wool
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1) •
surrounding 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 pits line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Date signed(nosh,day,year)
and complete.
Vei'yrg erica-Signature of Auditor I Date signed(month.day.year)
(
rt a7C-rTkfe . _r .ra,r t?STANDARD DEDUCTION ALLOWANCE`_ a aA,a,_4, i "[?-=yA'°'
20 / pay 20 4116 Lesser of 60%of the assessed value of the homestead or 545,000
Nolmthstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ DEC 1 1 2014
that is not assessed as real properly or to a manufactured home that is not assessed as real properly may
not exceed one-hall(12)of the assessed value of the mobile home or manufactured home.
D gned,(ntmt-.day .,a
lyIry Yi ��
,/ mil_ \ / - a f`:wa' '
TOR
DISTRIBUTION: (anginal-County Aucxtor,FieSamped Copy-Taxpayer