Homestead_Schurrer nP CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
_�.• T STANDARD/SUPPLEMENTAL DEDUCTION FORM
di` Save Form 5473(Rlbl 5-14) HC10
• t. Prescribed by the Department of Local Government Finance -
INSTRUCTIONS:See reverse side for Wing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-I.1-12-37.
I(We) certify that I(we)occupi as (o n al
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (dale ofsgnature7,) I4W3):
w9 Own. ❑ Am(are)buying under recorded contract. MI 17 O ZO�
❑ 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,.idence i e/"
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. r. ' -tiefIll.
__. _ __ ._.. .: ._
. -:
II toying on contract,Fee Simple owtse(s name
Recorders o3ce where coarad is recorded Record number 1 Page
s' -L '3_ _< F_ PROPERTY DESCRIPTION-:3-° e40-43: •- _r� �zr '4-"_3?z
County
Township Taxing distil(dy.rust],torn
Parcel number Legal description Is the pcopery in ea5wc
meal property de.cisAnnually assessed motes home(IC 6-I./-7)
d any portion of the residential structure or tie land not exceeding one(t)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property rtil¢ed to produce mar*.
Q I,- /7- 0 9 • 000 000 90 `/ -d, l
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sates,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
stgare pLda' ant n r/ e
PC
I hereby certify the above statements are true,correct,and complete. XlI//Y��c� ��X �et/1/Lr2„i
Address of Contact(number and street t%y,Sate,arid ZIP code) Address of vacated homestead,if any(number and street my,state,and ZIP code)
601 S 03-0 a) 6w @Asti( I/4t '.J 47600
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(1)acre Immediately 0)surrounding residential improvements
Other land (2)
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4) I
Annually Assessed Mobile I
-
Manufactured Home Garage (5)
Other improvements (5) .-
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor bas signed(month,day,yeah)
and complete.
verifying action-Signature of Aut:or Date signed(month,day,year)
Ire—'' . -'ji_-•v c:— STANDARD DEDUCTION ALLOWANCE ' W;__r_- � s }=Kis.:-� =r
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 64.1-12 to a mobile home $
that is net assessed as real properly or to a manufactured home that is not assessed as real properly may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature o divot �i�i'; / Date signed�0day Yeah
DISTRIBUTION:Ongiul-County Auditor,Fie-Stamped Copy-Taxpayer