Homestead_Luecke CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
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4 STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5473(R15/614) HC10
' Prescribed by the Department of Local 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.
- - - _ _;_ CERTIFICATION STATEMENT.'' F _- - `•'4•-=,r•-- �
/1 L /-371-37
I(We) Q/ e certify that I(we)oc etl s t (o r)` i�]
place of residence or am(are)buying the following described real property under contract for which a Horad ' -.n- - ■-
DeduCdon is hereby claimed on the date this application is signed, _ (date of signature).1(We): C
❑ Own. ❑ Am(are)buying under recorded cont-act. 1 act. JUN 9 2015
❑ Arn (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 pe • I resides - t -
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. l , ringr
- — -
If buys on contact,Fee Simple owner's name
Recorder's afire where contract is recorded Record number 1 Page
fl.'.. .: ..••"-r... -.,.75'. r _d, -Q.v-s7;-PROPERTY DESCRIPTION 7sxltair71.-. 7- -:7 .'au7.-x}y'°° ..
Cpuny Township Taxing disbiC(cry,town,township)
Pafml number all desaiaion X pro p .y in question:
�/� i/ e__ it t y ❑Real property Annually assessed ngbie home(IC 6-IA-7)
If any portion of the resdential stucure or the land not exceeding one(1)acre that immediately surrounds that stuctura is used to produce income,describe the use and portion
of ale property wl¢ed to produce income.
; / 7 -o z- 9&O _ 00 S. agy_oi /
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sae,Carey,and Town tip Is claimant vacating a homestead?
❑ Yes ❑ No
1Signr reofdabVm
I hereby certify the above statements are true,correct,and complete. ,( '727
Address of con (number and street c7:state,and ZIP code) , vacated rdy,
Andre of vated , any(number end street state,and ZIP code)
1C ?S i S . Racy Ow& sv I Znh
Land not exceeding one(1)acre immediately I(1)
surrounding residential Improvements
Other land 1(2)
Total land(line I plus line 2) I(3)
Residential improvements or Dwelling I(a)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6)
Total improvements(line 4 through line 6) I(7)
Total value (line 3 plus line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor Data signed(moan,day,year)
and complete.
V y'ag action-Signature of Aud"ior Date signed(money deg year)
-Y- gia- --.'.�. +-E. _t-- STANDARD DEDUCTION ALLOWANCE.-.r` c`;,". .i _ =T
20 pay 20 Lesser or 60%of the assessed value of the homestead or 545,000
Notwithstanding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1R)of the assessed value of the mobile home or manufactured home.
Signature...41 of „Ai lines.
Date signed(n. '.dag Year)
DISTRIBUTION: Original-Cowry Armor,FieSamped Copy-Taxpayer