Homestead_Hyatt " CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
--A T. 4 STANDARD!SUPPLEMENTAL DEDUCTION FORM
State Font 5473(1215/5-14) HC10
• � Prescnbed by the Department of Local Government Finance -
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,drivers license,stale identification end federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFlCATION STATEMENT' _'- 5( } " ^ t ,
I(We) , fi S' ��%y�_IY/L_r//_ff certify that I(we) u•ied•s , (o r)�nn .i '�
place of res dence or am(are)buying the folio '••described re.+l•rope under contract for which a Horn-1 ead 'rope ix tandard
Deduction is hereby claimed on the date this application is sign-•, (date of signature). I(We):
YC
,'{�"''�' ❑ Am(are)buying under recorded contract. MAY 6 2015
Li Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
ID Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pens I reside
o Am (are)the shareholder, partner, or member of the entity that owns the property.
" -
- :°_-- -
It buyi9 on contact.Fee Si-.p:e comers name
Recorders office where contract is recorded Record number Page
'_ .r.'-{ - "'t •=.'%PROPERTY.DESCRIPTIOA�' -F�v-•'
Cou.Y r Township f Taxing .• i..foam 1ownNy'r
//l!/nco6tc
Parcel number Legal description Is M property in quesvon:
eat property ❑ Pnnuafy assessed mobile borne(IC 6-L1-7)
It any portion of the residential sauaare or the land not exceeding one(1)acre that immediately sunou s that sbuaure R used to produce income,describe the use and portion
of the property ttaized to produce income.
a 6-/ g- 67- RQ '/ affE5 2:0S' oa k
•
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,Carey,a !.e ac / Is claimant vacating a homestead?
At ler P ❑ Yes ❑ No•sx-re oi -am
I h- -•• certify the above statements are iru-,correct,and complete. of .incan 4
less of Dante (number and street ray. e,end LP code) aca:ed homes eked(number aty ate,and ZIP nude)
I - ')qd k I I GiaileAi.,rerr*/,2 ,/®roc
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NONRrESISIDENTIAL
UE
Land not exceeding one(1)acre immediately I(t)
surrounding residential improvements
Other land 1(2)
Total land(line f plus line 2) (3) I I
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage I(5)
Other improvements I(6)
Total improvements(line 0 through line 6) I(7)
Total value (line 3 pins line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Ms-dying aoJM-Signature ot,W::o Date signed(rsmth,day,year)
iw '17 . ue- r;KSTANDARO DEDUCTION ALLOWANCES _.„,"T .9,. _( a -.;
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 6-1.1-12 toe mobile home $
that is not assessed as reel property or to a manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Sgnah�n 44�AWdw ��77 Date signed(month clay,ye n
DISTRIBUTION: Original-County Auditor,Fie-Vamped Copy-Taxpayer