Homestead_Martin (7) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t'0y I STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R151 St4) HCIO
Prescribed by the Department of Local Government F once t
INSTRUCTIONS:See reverse side for filing instructions. :
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
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I(we) t/ir L� certify that I(we)occupied as my(our)principal 2075
place of residence or am(are)buying the following described real property under contract for which a Homestead Property T. Standard
Deduction is hereby Claimed on the date this application is signed, (date of nature). itr - ' •
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SOwn. ❑ Am(are)buying under recorded contract )B$QN C. eIr/1,ti'er
El Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. OUNTY[UDITn R
ID Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am art)the shareholder, partner, or member of the entity that owns the property.
If buying on mnaacy Fee Simple owners name
Recorders stare where mntrae is recorded Record number 1 Page
1.17.- 21:::P-2.4:51:57-1•`2--;:2-' _ _PROPERTCDESORIPTONg:rim. r S _::n ..;r
. • ' r TdwetsNp fv Tat:,d ( r,town,ton "tp)
Parch na Tn Legal desaiWmy 9 Is the propecy N question:
arZi/yid/- Q�e o14Oe aG- OO / `s thei/Real proper:y ❑Annually asuased mobde home(IC 6-1.1-T)
If any portion of the residential sPucure or the land not exrsediq one(1)acre that L•nxda:ey aunt rids that suuaure is used to produce income.desaiae the use and portion
Of Ne property tared to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
sate,Casey,and Township Is Claimant vacating a homestead?
❑ Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. n n
/a"/ �.2/
Address of portal(number and street,aN.state,and ZIP code) // r of vacated homestead,I any(number and street.any,state,and ZIP code)
/00 ,4 u /S reel ,Ty uL y_.a ILIA/ .
ASSESSOR USE ONLY. I ASSESSED VALUE I HOMESTEAD VALUE I NONRESISIDENTIAL
VUE
ILand not exceeding one(1)acre Immediately I(1) I
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling I(d)
• Annually Assessed Mobile l
Manufactured Home Garage I(5)
Other improvements (6)
Total improvements(lined through line 6) (1)
Total value (line 3 pus line 7) (8)
I hereby certify the above is true,correct,
Signature of as�•sor Date signed(month,day.year)
and complete.
Vedyhg amen-Signature of Pie.:or Date signed(month,day.year)
__._ .LL. •, _., 'JS STANDARD DEDUCTIONALLOWANCE k > = '—iris
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 lC 6-1.1-12 to a mobile home 5
that is not assessed as real property or toe 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.
sgnatae of Author 'Date signed(Hork day.year) •
DISTRIBUTION: Ongi al-County AW:.or,Fie-stamped Copy-Taxpayer