Homestead_White (7) a t CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
E ? STANDARD/SUPPLEMENTAL DEDUCTION FORM r
• \�,� r2 Sate Fonn 5473(R15I 5-1a) HC10 /5/
\,.,�t Prescribed by the Department of Loral Government Finance
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INSTRUCTIONS:See reverse side for tiling instructions.
NOTE:Telephone,Social Security driver's license,state identification and federal identification numbers are confidential under IC 66---1..1-12-37.
I(We) 1/4.71( e/� i certify that I(we)occupi o )pun al D
place of reside or am(are)buying the following described real property under contract for which a Homestea r pe T S• n �.
Deduction is h eby daimed on the date this application is signed, (date of s• to A I
•Own. El Am(are)buying under recorded contract. APR 9 2015
ID Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. A
❑ 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.
If hying on aW1ac,Fee Simple owner's name
'Recorder's office where contract is recorded Record number Page
..'S
_ Q, ;PROPERTY DESCRIPTION'y__=+ — —_.t gu ,:
County K
Township I Tilting d'¢',rgf Idly.want C/•] Q
Parcel number Legal description I Is the rty in question:
cSteal property ❑Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residen..al=Cure or the land not exceeding one(1)sae that'unmedateh surrounds that Y.tuRun,S used to produce intone,describe the use and portion
of the property tied to produce income.
2_ 1 - i3 -i3 -to - 13 ,30o oo I , c°3. °° 40
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sys,County,a d Township Is claimant vacating a homestead?
❑ Yes ❑ No
,;,/j,�
I hereby certify the above statements are true,correct,and complete. C/��'
Adcress of contact(number and street,dry,state,and ZIP code) '•nest 045 red ho sad.d any(number end sheet coy,Sete.end ZIP code)7‘0 so
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NONREASIIDENTIAL
VUE
Land not exceeding one(1)acre Immediately I(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 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is we,correct. Signature of Assessor Date signed(north,day,year)
and complete.
Verifying action-Signattre cf Pud:tu Date signed(nson.•A eay,year/
20 _pay Lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(112)of the assessed value of the mobile home or manufactured home.
\raiy(J�/!/C..t.� ��y��:yL(/ Date signed growl,daY.Mar/
DISTRIBUTION: Original-County Astor.Fle-Sapped Copy-Taxpayer