Homestead_Seib (2) ailCLAIM FOR HOMESTEAD PROPERTY TAX �y
^�� e FOR minima
, STANDARD/SUPPLEMENTAL DEDUCTION HC1 �- d
State Form 5473(R15 15-14) el
'. Prescribed by the Department of Loral Goverrrnent Finance
INSTRUCTIONS:See reverse side for fling instructions. APR 11,6 2015 .
NOTE:Telephone.Social Seamty,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1-12-3 T.
• CERTIFICATION STATEMENT- .- - — : - At " -
OO/ /
I(We) 1 !_i—_ ie_I_A • - • certify that l(we)ocalpi-• 11114-Ar..Y.17v: '
place of residence or am(are)buying the following described real property under contract for which a HorQ� rtg J a 4: •y y ,
Deduction is hereby claimed on the date this application is signed, (date of signature). he: A )TOR
❑ Am(are)buying 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.
It toying on canted.Fee Simple owner's name
Recorder's of*ce where contract is recorded Record number I Page
-""'6- -; -y_ ___- i °_' '..'..--T t..t- DESCRIPTION' .J .,,.*y_z; .6+e„_s° ick,ig`_
Caney I T. ship • 1P)
Parcel number Legal desmpimn I Is the property in gues.idf:
9nenl Property ❑Annually assessed mobile home(IC 6-1.1-7)
If any pardon of the residential stuC.re a Me land not exceeding ore(1)acre that immediately surrounds that sbudure is used to produce income,desaibe the use and patron
of the popery tad¢ed to produce income.
a ea-ict -1 y _ 103 0o 1 . 2 / 6 - 0,2. 6
PROPERTY OWNED ELSEWHERE BY CLAIMANT
1 s .Cy,a Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. II P�+��nt0-C-
IAddress of contact(number and street nay.stare,and ZIP Oae) Address of vacated homestead,d an .0 and street a)i sae.&d ZIP cede)
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NONRESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential Improvement
Other land (2) ,
Total land(line 1 plus line 2) (3)
Residential Improvement or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
IOther improvement (5)
Total improvement(line 4 through line 6) (7)
Total value (line 3 phs line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day.year)
and complete.
Verifying action-Signature of Aud'eor Date signed(month,day,year)
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 one-half((122)of the assessed value of the mobile home or manufactured home.
Da tam./-
• ins
DISTRIBUTION:Original-County Auditor,Fie-Stamped Copy-Taxpayer