Homestead_Skelton CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
iA_ 1. STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R15/5-14) HC10
Prescribed by the Department of Local Government finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 61.1-12-37.
_. a- _ _ _ — - CERTIFICATION STATEMENT -' .
I(We) f_filli��5/ d,� 1 arm, ! ,J y certify that I(we)•..•cr•- m (our)�nwy,a
place of residence or am(are)buying the following describ-• real property under contract for which a Homes a• Pr Tax •
g D:
Deduction is hereby claimed on the date this application is signed, (date- n I
❑ Own. ❑ Am(are)buying under recorded contract.
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. MAY 4 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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Reader's o5ce where contract is recorded Record number Page
vSPROPERTY.DESCRIPTION,..'.ic.sF _.:':'3'`- f1..�;1:3 ' -c-Iti3-'xac<'<_
t� _..:h: .c c'.`.� _
Count 'Township r Taxing district(crly(own tounsnp)
Parcel amber Legal desaipion Is the property in o bon:
�T,
. yA /.oyAL
I r yet- / 1-1-1 0 ❑Real property ❑ Annually assessed mob de home(IC 61.1-n
e any Dmon of the residersial s'JUCae or the land not exceeding one(1)acre that irmnedtately surrounds that structure is used to produce income describe the use and portion
of the property If$ed to produce inane,
lit lo -oS-o /- L/p0 - 000 . 0a6-0/2
PROPERTY OWNED ELSEWHERE BY CLAIMANT .
Sate,County,and TownsNp Is Claimant vacating a homestead?
❑ Yes ❑ No
Sgwtu clamant
I hereby certify the above statements are true,correct,and complete. Al rte$//a/( • ;,/
Address of coned(number and s3eet My,sal end ZIP rode `'Address of van. hornet ad,den (number and street Y.state,and ZIP code)
‘111Q
a
: � '/ :i y76s%6I
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NONRESIDENTIAL
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 d through line 6) (1)
Total value (line 3 phs line 7) (6)
I hereby certify the above is true,correct. Signature of Assessor Date signed(month,day yeah
and complete.
Verifying action-Signature of Auditor Date signed(month,day year)
c y, ':7 _ vim.. tea--STANDARD DEDUCTIONALLOWANCE ._ .,.Y2. ti:;�'1'c_'-'`,`=`.=mot
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Nohtithslanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as may property or to a manufactured home that is not assessed as real properly may
not exceed one-had(1R)of the assessed value of the noble home or manufactured home.
•Signature of Audtpr rc Date signed(month,day,year)
DISTRIBUTION:Original-County AW:n.FlieSamp d Copy-Taxpayer