Homestead_Crowe •
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4 STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sax Form 5473(R151 5-14) HOW
' Presaibed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instrtjetions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-las.
.. - ".._- ._. - _: 'nf. CERTIFICATION STATEI.1i NT` ,- -
Minn F:
I(We) 7�sn�i � / o i -rtify that I(we)occupied . y( I pj nci l .1
place of • idence or am(are)buying the + awing described`-I property under contract for which a Homestead Property Tax Stan•a •
Deductb is hereby claimed on the date application is signed, (date of
signature).M}r ye):
� �,, ❑ Am(are)buying under recorded contract. / r C 2015
015/o--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 persona 3•enoe t 1.t.
❑ Ann (are)the shareholder, partner, or member of the entity that owns the property. GIRSO ei ji.
- ' '- „zz'. . .
If buying on contract Fee Sande owners name
'Recorders office where contract is recorded Record number 1 Page
..tit z�s:z�. _> r_.=...sx�)- -r2.-. - •,..tiPRO PERTY:DESCRIPTI ON+n� -sari.>r . . ._. -.t `�a
County Township Taxing rC(otg t R township)
ea
Parcel number Legal desoiption I Is th�eIrroopery in question:
Ly0?lal property ❑ Annually assessed mobile home(IC 6-L 7-0
If any portion of the residential saunure or the land not exceeding one(1)acre that immediately surrounds that s•.rvrure is used to produce income,desmbe the use and portion
of the property utilized to produce income.
a lc_z3-J 40 - aOo 00 5gii 40 - oa ci
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,Courtly,and Township - Is claimant vacating a homestead?
❑ Yes ❑ No
•Signature of clamant
I hereby certify the above statements are true,cortect,and complete. )(,i� e e-
Address of mnad(number and street.My Kale,and ZIP code) Addressor vacated bonehead.if any(number and sheet coy.sate,and ZIP cede)
,lame3 Me 4ada Cr /-ktLstJ1> w '/7E3I
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(t)acre immediately (1)
surrounding residential Improvements
Other land (2)
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling I(4)
Annually Assessed Mobile I
Manufactured Home Garage I(S)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is W e,correct. Signature of Assessor Date signed(month,day year)
and complete.
Vedyag actor-Signature of Audit r Date signed(morph,day,;ear)
eCi Y �_T-' .TT4 v_ww. a ° r„... xJF°-'yr'",I xp -F+tm-..I:
1_-1f'= - . s1}sc STANDARD,DEOUCTION AI.LOWANCE��'R,� -�� ;, .�J!e=`�e...' .4i:T' -�;,;
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 to a mobile home S
Nat is not assessed as real properly or to a manufactured home that is not assessed as real properly may
not exceed one-hatf(12)of the assessed value of the mobile home or manufactured home.
Sig r Date signed(=Mit da year)
.A .t. t Ls-/I
DISTRIBUTION: Onginal-County Auditor,Fie-Stamped Copy-Taxpayer