Homestead_Huck /` CLAIM FOR HOMESTEAD PROPERTY TAX i YEAR
r: � STANDARD I SUPPLEMENTAL DEDUCTION FORM
rCj/ Sate Form 5473(R15I514) ) GIO
. " Presented by the Department of Local Government Finance
INSTRUCTIONS-See reverse side for filing instructions. •
NOTE:telephone,Social Security,diner's license,state identification and federal identification numbers are confidential under IC 6-1.142-37.
.. CERTIFlCATION STATEMENT_ :- . - - - _-.
/r s
I Me) - w�. ■l:. - - certify that s .g)o: u d as'�i�u�t /u/r .. al
place of r'idence or am(are)buying the following t 'bed real property under contract for which Hom tepsFe lard
Deduction is hereby claimed on the date this application is signed, - (date of signature). I W ):
✓e
❑ Own. ❑ Am(are)buying under recorded contract NIA? 11 2015
❑ 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 resid-r1 e
❑ Am(are) the shareholder, partner, or member of the entity that owns the property. U
�4273Pf
•_ ... - .� .. . . _ <..
_...•
If braying on.contact,Fee Simple owner's name
Reca_3ers office where contract is recorded Record cumber {Page
County Township Taxi. strict(off town,township)
I
Parcel number I Legal descry:on �yoO ? Is the property in question:
t'•ri-i/ y�z., p/} / 7 ❑Real proper, ❑ Annoatf assessed mole nome lie lilt4)
If any per on of the residential structure or the lax not exceeding one(I)Sae that imt.da:ety surrounds that structure is used to produce(race.describe the use ant poroon
of vice p:ppe:y utilized to produpe income
>.a -o / - ac/ - Soo - 000. ? e/ - o city
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacated a homestead?
[I Yes ❑ No
Signature of clamant
I hereby certify the above statements are true,correct,and complete. ,,
C 'ft
ss of rorkaq(number and serer',ay,stare,end ZIP code) f Ada( so`vaca:ed.'mrr z•.=_ae.f any(number and SreeL�a'a:e.ax ZIP Mee)
Land not exceeding one(1)acre immediately
surrounding residential improvements (1) I IT _,
- --
. -
.
Other land (2) - ' '_ Ip�T•�,' Igryl gyp----�s'
Total land(line 1 plus line 2) (3) I` — - - _- - I Y 9 f '
II ABJ_ RRn r1 1 :
Residential improvements or Dwelling (4) I_-
Annually Assessed Mobile I _ - - -----'
Manufactured Home Garage 15)
I -MAY 1•-9-20151
Other improvements (6) ly. - _ '__ - -'�_ I
Total improvements(line 4 through line 6) (7) t
Total value (line 3 pits line 7) (9) _l BSC N_GQVN� R
I hereby certify the above is true,correcq
Signature of Assessor I ease signed truant.-,cay)mar
and complete.
Venfdr:g armen-Sgra`ttre of AUdtw Date signed(momt\Oar,yea,)
:P4: _ _ ` .._' - -17 t----r-STANDARD DEDUCTION ALLOWANCE= s . :; - s " >. ..
20 pay 20 Lesser of 60%of the assessed vane of tie homestead or 545,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(;2)of the assessed value of the mobile home or manufactured borne.
S gtta�/.7:/�of At 4or ( - Date si;ne:(mono.cast:feel)
( itt-Ci vL(t
DISTRIBUTION: Ongral-County Auden.Fie-Stamped Cory-Taxpayer