Homestead_Knapp re CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
�— i STANDARD/SUPPLEMENTAL DEDUCTION FORM
s- State Fonn 5473(Rf5/5-14) HC10
••• Prescribed by the Department of Local Governmera Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers am confidential under IC 6-1.1-12-37.
CERTIFICARON STATEMENT• .T.''..
w.
i ,'e (Pr;r1/9..S1 I 1. _ _ ♦ •, • 1 ill certify that I(we)occupied as my(our)principal
place o residence or am(ant,wing the •.7wing descri•-• real property und: • tract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date th application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)burying under recorded contract.
❑ 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 residence trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
_ =Zr..iixila -. ;CLAIMANTS INFORMATION _ - .•_ > a
_\
•
Recorders o5re where comaad is recorded Record number Page
x::Y-o2.+._ ::=5fr--:1:4i2- '.tt":i77-1:::::::;PROPERTY DESCRIPTION.�" `Yx 7.,L,. v..e•:L �:tiR".zW ';
County Township Taxing datia(dy,loin,/oohs/z) i
Parcel number Legal description Is the property ix question:
a.I Rig- 300 - CO : . 3Q0- O d S ❑Real propery ❑Annually assessed motile home(IC 6-1.1-7)
II any prom of the residereial smut^ e or the land not exeediy one(I)acre that umpdia;ey surrounds that stud=b use_to produce income.desa'be the use and portion
of the property utd¢ed to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
&ate,Carry,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
5 :
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and saes cily sate.and ZIP code) .�?41c4 .rated h'omestead,d an it be,and Creel rly state.end ZIP code)
_ .i _ S . '. tr(4 7nV �Y e VVV V
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(1)acre Immediately I 11)
surrounding residential Improvements
Other land I(2)
Total land(line 1 plus line I) 1(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 true,correct•
Sgrayre of Assessor Date signed(math.day.year)
and complete.
ye-yi g action-Signature of AA:tor Date signed(month,day,year)•
7.3 _ --rr`..-•c..-srT- z:-^°--STANDARD DEDUCTION ALLOWANCE?„y )L_ ?.='G•'s` • •_ -7-11q.
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 S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed e-half of the assessed value of the mobile home or manufactured home.
Sono re of � Date signed(month,day year)
ia- LI—►y
DISTRIBUTION:Origwl-CaurayAud.:or.FteSamped Copy-Taxpayer