Homestead_Fetcher (2) .-io CLAIM FOR HOMESTEAD PROPERTY
YEAR,] STANDARD SUPPLEMENTALDE UCTION FORM
Stale Form 5473(R17/1-16) HC70 r iyas l
Presoied by the Delmmnerl at Local Government Roans,
INSTRUCTIONS:See reverse side kitrlarg nstrurlmns.
NOTE Telephone,Soda!Seaaitt drivels tense,state iden55ra5on and federal federal idesecton mangers we confidential under IC 6-1.1-12-37.
I(We) • certify that I(we)occupied as my(ors)principal
place of res nce or am(are)buying the lolbwing desaibed real property under contract for which a Homestead Property Tax Standard
Deduction• hereby claimed m the date this application is signed, (date of signafu/e). I(We):
❑ Own ❑ Am(are)buying under recorded contact.
❑ 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 temps of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
Cant TomsNp Taxing fl(dl:town,tom:Nb)
Li .t
Patel reenter lwdeuaip:m a �NTY AUDITOR
�pWety ❑Assay assessed aabea home(IC 641.7)
If wry port«,of the rescem¢I strings or es lap not!teen g tee(1)an that nmedamN snande that shumae is used to produce"Scam,describe the me ale portion
of the property tithed to polo ammo.
096- 1 /- G- W- goo337 -o+a
.. .-:::�, -7
. 7:PROPERTYOWNEDELSEVIHERE BY CLAMANT ter, 7 C ,-..r-}Cx`.iF--_
Buse,Carry,aid Toensltp~ Is claimant vacating a homestead?
❑ Yes ❑ No
Eamad
I hereby certify the above statements are true,correct,and complete.
` 7:0,0
t. diH
7
contact(mrtbaa d leak.my,Nato end ZIP code( ,ailed tomessad,f wry(number red are coy,sib,and ZIP coda)
7aD ' s/Vac AI
.ASSESSOR USE ONLY _ i ` "ASSESSED VALUE.; • HOMESTEAD VALUE ,_)I -' NOtY-RESIDENTIAL
surrouncEmg residential bn) pravernents eery (1) �rdS s.--tz' t
d .. 4�Other and (2) �.....,.:-. .C.11)U
cam. ..
Total and(line 1 plus Une a (3)
Residential improvements or Omitting (4) .Cs -
annuaq assessed mobile/ I{
manutachsred home Garage (5) r74 s - r r
P [ --^
Other improvements (6) S.;_z z-a::;:d21.54-2:-.r"--v•-d51-a2.
Toal improvements(line 4 through lee 6) (7)
Total value (line 3 plus line 7) (a)
I hereby certify the above is true,correct, Si)v=aSa°Assessor Dale signed(arng'.thy'ea)
and complete.
Veyytg action-SRaeae of Nagar Data*fled(rte rte day-Year)
-'-" --- -'' `STANDARDDEOUCTIOfd ALLOWANCE„z Y _
20_pay 20 Lesser of 6056 of the assessed vale of the homestead or 545,000. 4•
No&Ngsta ce g any other provision the sum of the deductions provided in IC 6-1.1-12 to a motile home $
mat a not es coal property or to a ufaraned home Malaria not assessed as real pope*may
rnf exceed of t fthe assessed awe the mobile home nbnndamned hone.
Sighs,atAndler - ■ sae n+a'm,dal;
�� °77-1 fin
DiSTROuinON:Odder-Catty Az F45anpd Copy-Taxpayer
Page 1 of 2
Fev.; 'r.c tG 575 lo Be i ea n u o ca e
7�escn^eo By Sia;e ?az:a m iaz Commission:rz �
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR.19� ��
SEE B CK FOR FILING INSTRUCTIONS
''b"e) certify that on the 1st day.of
h, 19 I, (1Ne) occupied as our principal place oi residence the following described real properiy for
ch a Homesiead Properiy Tax Credit is hereby being claimed: �
� B no5'-�� ' �S-oo559 ,
�. (ave) owL�� ned � p S' �
❑ are buying under con a t
❑.have a beneficial inter,e in�,the taxpayer �iG_/��C_ ?�O -O� ��.7-�°�
/ � .J
Property Description in / �� wl��o
Taxing District (City, Town, Township): /
Parcel N�mber or
.
�i buying Ofl coniract: Osvners name ��ee simple o.:nerl
ripti
Township
shown on tax statement:
� �II � )� -Z_I?'
Coniract recorded in Recorders Office - Record No. Page
If any poriion of the residential structure or the land, not exceeding one (1) acre ihat immediately surrounds that
siructure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in �vhich individual o�vns or is buying real property:
reby certify ihe above statement is true, correct and complete.
0
County Township
�v — ` 6: ee A ef \ . , ' . _ .. .. . : Giry. S:ate ana Zio �e
�; _ � � . . . . . - . ,
Individual eiiher owns or is buying under a coniract that provides he is to pay the property taxes
on the res�deu�ce, or��#ias a beneficial inieresi in the taxpayer.
iJ - F,OR,�ASSESSOR'S USE ONLY -
:liX/)2.L �v � . .. _,
AUDITOr; �
Land not exceeding 7(one) acre immediately
surrounding r.esidential improvemenis
Other Land '
7otal Land
R2sidzntial Improvements
Dwelling
Garage
Total
O:her Improvements
Tc 'mprovements - Line (6) plus (7) equals (8�
I ��oy certify the above is true. correct. and compiete.
S�gnz:ure e: �ssesso�
%ZPOfO`J^4�
True Cash Assessed
Value Valuation
(�)
(2)
(3)
(4)
(�)
(6)
(�)
Ig)
Da:.�
Homestead
Valuation
Date: ( /� I��