Homestead_Sollman (14) ACLAIM FOR HOMESTEAD PROPERTY TAX YEAR
jar STANDARD/SUPPLEMENTAL DEDUCTION FORM
11 gy State Fain 5473(R15/5-14) HC10
'---ii,"1.7' Presrnpee by the Department of Local Government Finance '
INSTRUCTIONS:See reverse side for filing instructions.
7J4 i � enJ MOGC#certify that I(we)occupi: a /(o I/ print al I�\
place of r-sidence or am(are)buying the following descji -d real property under contract for which a Homestead 'roe n
Deduction is hereby claimed on the date this application is signed, (date or signature).DEC(We):
Own. ❑ Am(are)buying under recorded contract. (, j 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 perso esidence trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. i
_ _ :.eaiir�ei •
- mr.t. ___ i _ . . ..CLAIMANTS INFORMATION a ° . 7_* _ _ - jCrw ,±. r
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Readers once where contract is mmmm Record number Page
g.;-- ,:: <.; f, T.?---1-4' y _ -,y t :_PROPERTY DESCRIP710N'-‘,.X_-.? -■ ,v;..`s--_„s-._a' -= - ..*_:7 �=4
CourEy Township 1 Taxing d' (cry town,
Parcel number Legal{ascription // X Is the properly in question'
/�� [� ..A /s'r r //y al yoperty ❑Amualy assessed rtpNe hwne(IC 6-1.t-7)
ea' pr Jon o::he resilemw eouCne or u»elaarid nd eooeda.gcIdro{((7))a/rte that inT die eh su .es- t soudure a used to Ixmum rate.desmbe the rue and porn'
of nn,T(jr�(_.,^mt _eM waged to produce vrmme.
A../2 45 -_eco-cog 40,--(6,2 V
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Saws,Canny,and Township Is claimant vacating a homestead?
// /❑ Yes 0 No
sir,ga claimant
i'(xv
I hereby certify the above statements are true,correct,and complete. .Sig reiD
Address of mead(number and street.ray,/sate,and ZIP code) Gress of vacated homestead,d any(number and sheet city,state,and ZIP code)
00/,5 tl 1 . . ve
Land not exceeding one(1)acre immediately 11)
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 tine 6) . (7)
Total value (tine 3 plus line 7) (8)
1 hereby certify the above is true,correct, Signature of Assessor Date signed(month,day year)
and complete.
Venyvg action-Signahrre of Nd.:a Date signed(magi;day,year)
y.° r- _=ir—'r-..='= :iSTANDARD,DEDUCTION ALLOWANCE,'=_ice=+Vic -- ' igi 7`:= .- `'51
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000 r
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-1210 a mobile home $
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Signature of Aerator Date signed(ninth,day year)
DISTRIBUTION: Original-Courny Aud:or,FleStamped Copy-Taxpayer