Homestead_Koberstein (3) •
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di CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
:4 STANDARD!SUPPLEMENTAL DEDUCTION FORM iv State Form 5473(R15 f 5-14) HC10
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% .. Prescnbed by the Department of Local Government ent Firance
INSTRUCTIONS:See reverse side for filing instructions. I I •
NOTE:Telephone,Social Security drerees license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
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,-4 — '• •••••• , • .CERTIFICATION STAlEMENTrt - - t- --. : Q--:,- '
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si• r, I
!Me) 41TAIWW511:1470117ffNifil,110.7_- • certify that I(we)occupied as 1 p(I r)dorinci2ir
place oflr-rd-• - or 71 (are)buying the following described real property under contract for which a Homestead Property Tax Standar
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Dedu 0 is ereby filmed on the date this application is signed, (date of Signat , I(yye):
Own. I:1 Am(are)buying under recorded contract. GIBSON
JD Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. OUNTSYA,,fl
ol
o Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence fruit"' 'TOR
El Am (are)the shareholder, partner, or member of the entity that owns the property.
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Recorders°Noe where contact is recorded I Read number I Page
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1-4i--.;232 ,::- -?..,;1"-- jTPROPERTYDESCRlPTiON/L,esan
County TownsNp 1 Taxi •des; ,Mi reship)
• <46 ou ff I I
Parcel number Legal descrian
eillf)
cat-'0itS1A004/0/. /6.6*- OC: 1 a the RePealeW in queltd? 0 innuallY assessed m°bIle ham°Ue 6-1.1-71
If any portion of the residential Sructse or the land not exceeding one(1)acre that anedatety surrounds that structure is used to produce incom e.descnte the use and portion
of use;copedy utlized to produce Mane
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.Carey,and Township Is claimant vacating a homestead?
0 Yes 0 NO
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Sigmium of claimant
I hereby certify the above statements are true,correct,and complete. ,?4 Via gi
Address at contact(number end asset city,Cafe.and ZIPI:arle) ' of vacated homeMead,it any(number and greet city,Nam end ZIP ace)
ASSESSOR USE ONLY -I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE•
I Land not exceecilng one())acre Immediately
10) I
surrounding residential improvements
IOther land 1(2) •
Total land(line 1 plus line 2) I(3) ,
-,. .
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Residential improvements or Dwelling I(4) .„
Annually Assessed Mobile/ .
Manufactured Home Garage (5) • .
Other Improvements (6) .
Total Improvements(line 4 through line 6) (7) .
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Total value (line 3 pits line?) (8) i
Signature of Assessor Dale signed(mona clay year)
I hereby certify the above is true,correct,
and complete.
Veniying amon-Signature of Audior Date signed(mon*day,year)
:
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 4 .
Nohothstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S • f
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-had(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(mast,day,year)
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DISTRIBUTION: Onginal-County Ruda.Fie-Sampee Copy-Taxpayer