Homestead_Horn " CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
;k = STANDARD I SUPPLEMENTAL DEDUCTION FORM
4:; Sate Form 5473(R151F14)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. •
NOTE:Telephone,Social Seventy,driver's license,state identification and federal identification numbers am confidential under IC 6-1.1-12-37.
• 7 7 7 7' - CERTIFICATI'O�N STATEMENT''r�- . - 1.7' I'i:,'"'''--
I(We) i4 -_, 4 • _..�i 2, ,i_#'—P'certify that e)''. {,ed.s 't . •l�cipal -
place o/esidence or am(are)buying the toll.4 e descri•`• real property under contract for which'. o '-' =a •roperty Tax Standard
Deduction is hereby claimed on the date this application signed, (date of sgnlat je) e):
❑ Own. ❑ Am(are)buying under recorded contract. APR 1 " ��
❑ 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 qualifi-• -rsonal.g- I ai - trust.
CI Am(are)the shareholder, partner, or member of the entity that owns the property. : 1/111"t
_
If buying on contract.Fee Strppe camels name
Recorder's office where contract is recorded Record number I Page
i . — •,-._-C -a;1PROPERTY.OESCRIPTION: .... -# l_F,,,.; . ,•a "='
Corny Township Tai •isuict(My:own,tmwmshq)
I 4 4
Parcel number Legal desaip en }� I Is the property in quesion:
7 / t i i / x4_4 Dial popery ❑Annually assessed mobte home(/C a-1./-7)
If any potion of the residential stixhne or the land not ex eedtBg one(I)acre that immediately surrounds�at strumure is used to produce income,describe the use and portion
of the property uhlt ed to produce income.
R &-a3 -07 _a oo - DoO. Y6V-o2 y
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.Coumy,and Township PROPERTY
claimant vacating a homestead?
❑ Yes ❑ No
lael mdM
I hereby certify the above statements are true,correct,and complete. sHs ',(/1/I//�J /�}�ilsry�Ja�1'LA
X Mn . and red{r.Sy/valB,a••ZIP•..:) ress o ,, ca,ed .ead.d any(number and street,cey,state,and ZIP code)
! �I Nl11. 1 !�Q fl • rIi to 1
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(1)acre Immediately I(1)
surrounding residential improvements
Other land 1(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 d through line 6) IV)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Sgnature of Assessor Date signed(month.day,year)
and complete.
Vedhi g action-Signature of Ammar one signed(month,day.year)
-es _- __, _ '-�-�'a`Y.a STANDARD DEDUCTION ALLOWANCE%$- s't�..-: x:17,—.' -..1...CS-w-=.y,='%_
20 pay 20 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 64.1-12 toe mobile home 5
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceeeedd one--haatl(7/2)Hof the assessed value of the mobile home or manufactured home.
Sigma/ of i "'✓ Date signed(month deY.year)
DISTRIBUTION: Onginal-County Auditor.File-Stamped Copy-Taxpayer