Homestead_Hunt (17) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
;a-_^.i \ STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1515-14) HC70
AP:L‘ Presented by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1-12-3T.
CERTIFICATION _.
I(We) ArAP.S4.711 /, certify that l(we)occu !- as y ii ur)Pri.'1-:I ;
place of residen -or am(are)buying the following described real.roperty under contract for which a Homeste Pro! t. . ..j da . ,'
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
Sown. ❑ Am(are)buying under recorded contract. APR 2 9 2015
❑ 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 residence trust.
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. 4
.s•. ._u Tlfi
:_ _ _
If buying on cone-ac.Fee Simple owner's name
Reasdefs oSce where contract is recorded 1 Record renter Page
_ ,_. a:-- :'t- :.'_'-. .4 PROPERTY OESCRIPTION . rz1,--4 : _�s s-"esF�ra._
1 Courtly Teatsf p Taxing scat' ,town,tcsnsh. )
`_ Sl ' 1a
Parcel ammber Legal descret,ion Is the property Si quezron:
yf(eal property ❑Arnualy assessed=tie home(IC 6-1.1-7)
If any person of the residential secure or the land not exceeding one(1)ace that immediately surrounds that structure is used to produce income.desmbe the use and portion
of the popery ud¢ed to produce income.
21,— AQ-07 Q0 o0 R. 9z/ 9 6o? 8'
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,Corey,and Township Is claimant va ti1g a homestead?
17I Yes No
ire of danmam
I hereby certify the above statements are true,correct,and complete. r-
/ao1� Ct /street Sri
■Mares,of..^'.ct(number and- -'t,al:^ and ZIP code) / Address of veered hcr•es;ead. -�(number and Street.est.star ZIP code)
/1' % ,_ _ 76 7
ASSESSOR USE ONLY ASSL'SSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (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 pits line 7) (8)
1 hereby certify the above Is true,correct, Signature of Assessor Date signed(nmck daY.year)
and complete.
Verifying hutch-Signature of Aucuor Date signed(mond;day.year)
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Nolwithstanding 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 properly or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the motile home or manufactured home.
Sgrat es f Audio Drs signed(month,acv.year)
N, y -a6
DISTRIBUTION: Original-County Auden,Re-.tamped Copy-Taxpayer