Homestead_Pollock (8) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORM
Sate Form 5413(R15/5-14) HC10
Prescribed by the Department of Local Goiermenl Finance
INSTRUCTIONS:See reverse side for filing instructions
o
NOTE Telephone,Social Secunly doer's license,state identification and federal identification numbers are confidential under IC•- ,- r
._ :MN ' - : 7' ' ' CERTIFICATION STATEMENT.; - - 'S - `i c` i)"..1'I.—•
I(We) ,�� _ ` �l�ri�1 fY ( ) p t Y ) Pa
• �� cera that I we Deese r• . m our principal
place of r-=dence or am(are)buying the following described real property under contract for which a Homestead Property Tax Stan rd,, C
Deductio / hereby claimed on the date this application is signed, (date of signature).JI )O.5 LOi•1
❑ Own. ❑ Am(are)buying under recorded contract.
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. I • I I ei
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal re f:,...- •n's p1
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. Ci(B.SQN CQLINTY AUDITOR
. -"'- ' M- — -.., ' v,
;?•. -.MT--I.:
< - 4 " '.;sN� > , l C1
If buying on conned,Fee Simple owners name
Recadefs o5ce where contract is recorded Record number Page
c` 4_W= :na -.. r,.. _ 4 '.PROPERTY.DESGRIPTIONrf. � t.;tL`i2.c?4�Px' _ :
County Townshp s..tr Taxing d'stia(oly town.townskp)
/� Parcel number al desoiption Is the property in question:
00/16-�a.0 - )C)q-COLT �- OD $ ❑Real ppww.y ❑Annually assessed noble home(IC 6-1.1-R
If any pardon of the residential toucan or the land not exceeding one(1)acre that immediately ssmounds that Yrjdure S used to produce icon.desmbe the use aid porn,
of the property dined to produce intone.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,County,and Township Is claimant vacating a homestead?
I
Yes fl No
gia:ure old v 9
hereby certify the above statements are true,correct,and complete. //
r
Andress of contact(number and r$: w
state,and 21Pde) I I'... s of ceted homestead,I any(number and Nauru ely state,and ZIP code)
ASSESSOR USE ONLY I'SSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line d through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above Is true,correct, I Signature of Assessor Date signed(month,day,year
and complete.
1 Verifying action-Signature of Auditor Date signed(north,day,yea,)
70_y ' -l'_rrii' _�'-- i` �;azil 177;=.4$TANDARODEDUCTIONALCOWANCE - �."',_.X�' - is'-
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Nots hstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ c
that is not assesse• real property or to a manufactured home that is not assessed as real property may
not exceed one-h. of the assessed value of the mobile home or manufactured home.
Signature of Ad.:or w Date signed(m t's.day.Ix:
� A - 1 -8 - IS
DISTRIBUTION: Origwl-County Auditor,Fee-Samped Copy-Taxpayer