Homestead_Beaman CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a_ 1 -STANDARD/SUPPLEMENTAL DEDUCTION FORM
{ Sate Form 5473(R15/5-14) HC10
• '• Preschbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for fdbg instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers am confidential under IC 6-1.1-12-37.
.. • -- `-q - CERTIFICATION STATEMENT ' . - r - - __-
I Me) WL ?J, / a tit: 4',i L- i �_f / - certify that l(we) i a y(oaa)plIln. .
place of residence or a Y are)buying the following described real property under contract for which a Horn ad ro rty T�1an. .
Deduction is hereby ciai ed on the date this application is signed, (d f s- I......(WyMlYty�/////.
KOwn. ❑ Am(are)buying under recorded contract APR q
LI A R Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 1-6 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.
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Rewrites o5e where contract is recorded Record number 1 Page
E, x .-7 =�.�- -._ --.-.P ROPE RTY.I)ESCRIPTION _a a_ erX_•:;e =cam- �'<_---'
Ccerr: N \ Tmvmlvp Taxing d¢'- (dgr,t n,fomshm) •�
Pita• _,i v� Legal descripfm Is die y in gu sbe-
("/Noce��—/6 • ,QVQ• 0 01 a f`aa 99. a a V I Real property ❑Annually assessed mobile Name(IC 61.14)
U any potion of the residential sa'ucttre or th ag nd not exceeding one(1)acre that inu nn{eeddiattteellyy/s/suurrounds that structure is used to produce income,describe the use and portion
of the progeny tf3¢e0 to produce irwrne. Il/YN_/ /1 ll / It xs
PROPERTY OWNED ELSEWHERE BY CLAIMANT
sr,County,and TownsNp Is claimant vacating a homestead?
❑ Yes ❑ No
Sig re d mat - /
I hereby certify the above statements are true,correct,and complete. / ,„ ,
Address of cenad(number and-. state,and ZIP.•s,) ress of vacated homestead.A any(number and sweet dirty state,and ZIP code)
/ • ;#12
a ' //
ASSESSOR USE ONLY I ASSESSE'3 VALUE I HOMESTEAD VALUE I NON yESISIDENTtAL
Land not exceeding one(1)acre immediately I(1)
surrounding residential improvements
Other land (2)
Total land(line I plus line 2) (3)
Residential improvements or Dwelling I(a)
Annually Assessed Mobile I -
Manufactured Home Garage (5)
Other improvements (6)
Total Improvements(line d through line 6) (7)
Total value (line 3 plea line 1) (a)
I hereby certify the above is true,correct.
Signature of Assxw Oats signed tricorn,day,year)
and complete.
•
Ved)A g action-Signature of AWitd Date signed(moth,day,year)
• 5. '-a%'� ;r=yCµ.._-ercubSTANDARD DEDUCTION ALLOWANCE';-- — Y;--S'_ `y _.,,__
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notmthstanding any other provision,the sum of the deductions provided in ICE-1.1-12 to a mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as mat property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
1 Slanatue of Auddbr Date signed(root:.”.day.year)
DISTRIBUTION: Original-Couray Auditor,Fie-Samped Copy-Taxpayer