Homestead_Masters CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
_ FORM
letp-a
STANDARD I SUPPLEMENTAL DEDUCTION FORM�... State Form 5473(R15/5-14)
7 '' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. 1 1. ',,3
NOTE:Telephone.Social iicunt%drivers license,state identi'n-r:n and federal identification numbers are confdenti ui de j • I.1-1 -
- c CFiRTIFICATIOV STATEMENT - _ ---1"1; _= -. - ..
1
I(We) \i 5 . ( \ tar A certify that I(we)occaLetagrA(00M4nciPal
place of residence or- (are)b .the .flowing described real property under contract for which a Honest o(IEriy reStandard
Deduction is hereby claimed on ate this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract. '
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. �R,dITT�yr AUDITOR
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a e�ASidehce trust
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
.- - CONTRACT:RECORDED
If buying on mntrae,Fee Simple owners name
Recorders once where contract is recorded Record number I Page
i-;tadra: _..: -sue _.w" _- 7'- :=.:PROPERTY.DESCR1PTIONZrr5' , r.�..rt- dit - s `s4
Cot Townsfup�. I Taxing d:sSir((aly • rIO�
�/ 1 l r \ I
Parcel number Legal desai/ppion��/q) is the property in queatan:
' / // `� eel P�+sst ❑Amualy assessed mocee borne(IC St.1-7)
r_(0-401-17—/cKt—oti
ny portion of the residential struaaa or the land not eaceedug one(1)aoe that immediately surounds that sttnxdure is used to produce income.deambe the use and portion
he property ttlaed to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sze,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature I claimant
I hereby certify the above statements are true,correct,and complete. ^ c •
Address of con'au(number and street are state,•• LPmde) Address of va at ornestead,d any(number and street are,gab,and ZIPmde)
tD S e. . —Gi.;. ,. 1I(/ iID 7,-) 76/a
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
• VALUE
Land not exceeding one(1)acre immediately (1) I .
surrounding residential improvements
Other land (2)
Total land(line I 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) (0)
I hereby certify the above is true,correct, Signature of Assesses Data signed(month,day,year)
and complete.
Veayivg action-Signature ofAUdtP Data signed breadth.day.year)
"_-. zir- F- _-°s ,,,,._ - ?STANDARDDEDUCTIONALLOWANCE-- -r`v f= _P 3' +''�-.4_
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Abmithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not coed one-hall(1/2)ofthe a ssed value of the mobile home or manufactured home.
sgr , of Author or �dayr ' a— (,.J
LI
DISTRIBUTION:Ongmal-County Auditor,FieSamped Copy-TasTeyer