Homestead_Schmitt (22) et "c CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-4 'e STANDARD I SUPPLEMENTAL DEDUCTION FORM ® '
State Form 5473(R151 5-14) HC10
'. Prescribed by the Department of Loral 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 6-1.1-12-37.
�• 'fi�t)):�- °"yy-��. CERT�IFICA1IO.N S�TATEMENT�•.� -T—'1(1 r -
I(We) S�/(r(f,T ri�y r r(a 1 J/ .l M r e =/- • iI illgrtify that I(we)occupl a m r ou 1 pri a oI
place of residence o am(are)buying the folio ing described real property under contract for which a Homestea• -rope . ax -n•ard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): C
IliOwn. ❑ Am(are)buying under recorded contract. MAY 1 S 20 5
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 personal r ence t -t.
p ri
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. 1� �lTllr
-
If buying on contact.Fee Simple owner's name
Recorder's°Gee where=tact is recorded Record number 1 Page
\s __,.. :sa ir—at z1PROPERTYDESCRIPTION�_ m '`aTY��e,. <;r.
Canty
Township Taabg debid(oty,town t• •a•
I
Parcel number Leal y
/ilidiesary•'- Is the Drcpeny v1 Cue m:
T�-T• ?•9-e 0?.5771 rL�/��p 1popery ❑Annuafy assessed motile home(IC 6-1.1-7)
If any portion of the residential st:con or the land not eaceedig ore(1)acre that 4rmsediaely swop a mat autcture is used to produce income,des.-•ibe the use and porton
of the property utilized to produce income.
24-a3-05 _300 -0oa • 604 -oay
PROPERTY OWNED ELSEWHERE BY CLAIMANT
1 State,Casty,and Township Is claimant vacating a homestead?
❑ Yes ❑ No ie
I
Signature of of/truant
I hereby certify the above statements are true,correct,and complete. )r K
/n.c. S
AWressmmmaa(narrmar and mot r>:r.state,and ZIP code) Inndres of vacated nor.,es:ex.dany(number and sDaat ay.rasa.am ZIP=de)
1 / 7 o S (or ILA, 4 a& 97&31
Land not exceeding one(1)acre immediately (1) I I - - •
surrounding residential improvements Itl
Other land (2)
Total land(line)plus line 2) (3)
Residential improvements or Dwelling (4) I
Annually Assessed Mobile I
Manufactured Home Garage (5)
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 true,correct,
of Assessor Date signed(month,day,year)
and complete. -
Vnstyvg action-Signature of NC:tor Date signed(north,day,year)
-✓.-•4-�'_ '._�== ,tif -,=v STANDARD DEDUCTION ALLOWANCE.-'- .1' -g?» -f ?C'�
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Abhvi:hsfanding any other provision.the sum of die deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real properly 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.
Dejed LIZ ��r,-.7--/f 8' /,5
DISTRIBUTION: Original-County Audtor.FWD-Stamped Copy-Taxpayer