HomeMy WebLinkAboutHomestead_Ireland (3) CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
r.4.1.-1 4 STANDARD I SUPPLEMENTAL DEDUCTION
.��aP� Sate Form 5473(R1515-14) HC10
+mil Prescribed by the Department of Local Government France /
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.
.. - .. - , ' -" CERTIFICATION STATEMENTc, .- +'--7 -i[1''7_, r - I I v
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I(We) /..-xf `I'- 'a ' OP \ ♦ . /. ..— certify that I(we)occupi-i a- m touI pa.a:=1
place of residence or am(are)buying the following described real property under contract for which a Homestea• • •pe i ax -ndard
Deduction is hereby claimed on the date this application is signed, (date of signature).. 21
I(We):
❑ Own. ID Am(are)buying under recorded contract. APR 9 5 5
❑ 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 re y 7gnce.w
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. 'AUDITOR
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If bvitg on contact,Fee Simile comers na me /
Recorders office where contract is recorded 1 Record number 1 Page
1-.s- r?=+- -f-"_•-_. ee, '.W.. .j-- a':PROPERTY DESORIPTIONWFi IZ +iz _,3r i —ac
County Tomisep Taxing disai t(tif/."�.m,WIMPS::hip) /�
1 Parcel number Legal description Isthth/iee property in question:
Real property ❑ Annually assessed mohie home(IC 6-1.1-0
If any portion of Me residenttal',rare re Di 4'te and not exreedig one(1)we that vrvrcduteh spurn. s that sttufzme is used to produce income.descnoe me use and portion
cf the property traded to produce inLme.
Z/-zo -i3- 6o coo. 77 / 00/
PROPERTY OWNED ELSEWHERE BY CLAIMANT
1 Sao,e«aey,and Township Is claimant vacatng a homestead?
❑ Yes ❑ No
&gar.I of clamant
I hereby certify the above statements are true,correct,and complete.
1 Address of contact(number and street.ody,state,and ZIP ) I Address of vacated homestead,d stre
any(number end et,day sate,end ZIP code)
xbegs. !Cot. C.hk C(4- PI "?
Land not exceeding one(1)acre Immediately I(1)
surrounding residential improvements
Other land I(2)
Total land(line I plus line 2) I(3)
Residential improvements or Dwelling I(d) I
Annually Assessed Mobile/
Manufactured Home Garage (5) I
Other improvements (6) -
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
1`/e-tying scion-Signature of/v�mr Date signed(month,day,year)
20 pay 2 _ Lesser of 60%of the assessed vdue of the homestead or 645,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed/on/ne-half n(12)of the aasssesseedmod)value of the mobile home or manufactured home.
Sir O e)2_2_[ ` Inn Date (rrpny-- yean
DISTRIBUTION: OngNl-Csumy Auditor.FdeSamxd Copy-Taxpayer 7/ �/r(/'../