Homestead_Hopper (2) •
fl CLAIM FOR HOMESTEAD PROPERTY TAX FORM STANDARD/SUPPLEMENTAL DEDUCTION Seale Form 5473(R15/5-14) HC'eO.0 n Prescribed by the Department of Local Government Flume
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INSTRUCTIONS:See reverse side for filing instructions. !B7 ! ,ti OS8/.�
•NOTE:Telephone,Social Security,driver's license,state identification and federal klentifica(ion numbers are confidential under IC 6-1.1-12-37.
® r CERTIFICATION STATEMENT � ce;''',
.I(We) ho �l f t _/ AP• -rtiry that I(we)occupied .�.it og)grt .
place of residence or am(are)buying the following described r al prope r ter contr-ct for which a Homestead Property Tax Stan are
Deduction is hereby claimed on the date this application is signed, (date;' )a
❑ Own. ❑ Am(are)buying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Haver )the .holder in the trust or the er of to t a enpy the property the pro the terms of a qualified personal residence trust.
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210- iY - lS- --/oz - coo o8- 9007
PROPERTY OWNED ELSEWHERE BY CLAIMANT -
State,County,and Townsmp Is claimant vacating a homestead?
❑ Yes��❑.02.................No Sgtuture of da /J!y't c.f I hereby certify the above statements are W e,correct,and complete.Pddre s o(wmac(numpererq sheet ally#ate,end Z/Pcod.) Address of v d any(number and d ZIP code)
;dig aleirDR # or A,</art/mb/7
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESISIDENTIAL
VUE
Land not exceeding one IN acre Immediately 10)
surrounding residential improvements
Other land I(2)
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling I(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) (8) &O1/0
Signature 'nature of Assessor Date sig - .' ♦/e� r)
I hereby certify the above Is true,correct. /
and complete. 1a t ,N a°J / a
Vedyvg acion-Signature of Auditor Date sig - 'F ,, 6) °ilia
® 20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 `�/////���py��yy��r /
Notwithstanding any other provision,the sum of the deductions provided in IC 6.1.1-12 to a mobile home $ a_al
Nat x not assessed(1 real property or to a value of the manufactured home that is not assessed as real property may �1�YL -^
not exceed one-half as re of the assessed value of the mobile home or manufactured home. •
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DISTRIBUGION:Olig;•ul-Co trey Pinter.Fiedamp.d Con y-QTaxpaayer/1O//
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