Homestead_Pugh (7) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
_ FORM
STANDARD/SUPPLEMENTAL DEDUCTION
a; State Form 5473(R1515-14)
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS:See reverse side for tiling instructions.
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential on(- • 1.1-12-3T.
- • • - ":1,. - -2 t' %-•CERTIFICATION STATEMENT-.: . .i 1 1 { 14 C -Tr 'v.1!. r.
I(We) nenr ��/ '— certify that I(we)o led `- ) s'n .t
place of residence or am(are)buying the following d:%ribed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of sign ` (We)'
2015
❑ Own. ❑ 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 pers I resid .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
�.
U buying cecontact,Fee Simple awre/s name
Remdees of5ce where contract is recorded Record number 1 Page
•
- :?t7 3jre - :✓� _ Ct PROPERTY.DESCRIP ION C?=3T..x a,. _az�.--S�_ i.=`• ?
County Twmstip 1 Taxing foray,town,fownshm)
�/ �/11-44I
Parcel number Legal desaiphon I Is the property in question:
/r/�///W. 1sel nI -al'a�. l l` sup Real property ❑ Annually assessed mobile home(IC 61.1-7)
If any potion of the residential sTSC o the land not exsedmg one(1)acre vatrimmMeter:els surrounds that=CUSS is used to produce income,desethe the use and potion
of the property irked to produce income.
,26 -1,2-07 - go 3 - OOe2 . 1 .14 - 0 ,1- 8 ,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,Garay.and Township Is claimant vacating a homestead?
❑ Yes ❑ No
gna:ure of claimant
I hereby certify the above statements are true,correct,and complete.
.R•
' Address of canted(number and street,red.state,and ZIP code) +r- ''7 Padres of vacated homestead,a any umber and street,aly,state.and ZIP code)
�[\\\ I S t l 1, t L
Land not exceeding one(1)acre Immediately I(1)
surrounding residential Improvements
Other land (2)
Total land(line I plus line 2) (3) I
Residential improvements or Dwelling (4) .
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6)
Total improvements(line 4 through line 6) (1)
Total value (line 3 piss line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor base signed(mmn:A day,year)
and complete.
Vetting action-Signature of Nd.:or Date signed(month,day year)
r - ' ":dren,_ tee. trlf '!`" >`STANDARD DEDUCTION ALLOWANCE' _. a:i1-7 rJ ti:-•�:._
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 $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
s;..aase offA /
Author ..��� Date sign (mutt ned(m ,day,year)
e
DISTRIBUTION: Original-Coudy Audaor,Fae-Namped Catty-Taxpayer