Homestead_Williams (13) 9•`17, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
.�s�@"l�� State Form 5473(R15/6M) HC10 /
��° � Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
I(We) certify that I(we)occupied as y u pri ipal t
place of residence or am(are)buying the following described real property under contract for which a Homestead Pro a St and R—q
Deduction is hereby claimed on the date this application is signed. (date of na[ I(((((({{{{{{yyyyyy���e gig 8 y N
Own. ❑ Am(are)buying under recorded contract
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. APR 9 2015
❑ 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.
4
a� • _ - .• :. CLAIMANPSINFORMATION� ..dam'; +_..s-...;,,39�4ii097/A
:
L'burying on conuaa,Fee Simple owners name
Reader's c:ce where contract is recorded Record rumba Page
County Township Taxing disaia(city,town,township)
Parcel number Legal description Is the property in
a 26-1$ �a 03 coo 9 �5 s
-
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature of ddunam
I hereby certify the above statements are true,c rlet.t,and complete. A� v ,//n-
Address of coact(number and sues.alit state,and ZIP code) �a�`O y(� Andress of vacated hane w
stead.d any(number and weal ply,state,and ZIP code)
'ya w(D00 s fog-t8 poc 1r
Land not exceeding one(1)acre immediately I(i)
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 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
v yvg as ion-Signature of Ald.tor Date signed(month,day,year)
�. ._,- - +S STANDARD DEDUCTIONALLOWANGE_
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 61.1-12 to a mobile home $
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not exceed one-half((1)2))�of f�the essess\\seed vale of the mobile ehhooJmlee or manufactured home.of Sy \ ///Y/L/L.L, \ Il �r�r=f/C/7Li DatVed(7,day.year)e
DISTRIBUTION: Original-County Auditor,Fie-Stamped Copy-Taxpayer