Homestead_Allen (3) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORM
Sate Form 5473(R15/5-14)di HC10
Presbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instmclions.
NOTE:Telephone,Social Sewn,drivels license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
I(We) certify that I(we)occupied as my(our)principal
place of resid ce or am(are)buying th following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract.
❑ 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 residence trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contact,Fee Simple owner's name
{/[_/
Recorder's oSce where 4mtrad is recorded Record number I Page
� : _, .�.... -_ _ - .,ii PROPERTYDESCRIPTONn. ._. ti-•C --tr <'.r^ -. a-T. !
Canty Township Taxing district(ay,twR tmnsh 3) .
Zialdeceeclatte-
Parcel number Legal desoiprmn i sce.Sc' p Ac I Is the properly in quesboru
- Pr se 34-3-// ❑Real property ❑Annually assessed motile home(IC 6-t.1-7)
It any pdrbon of the residential 5.rucNre or the and not exceeding one(1)acre that immediately surrounds that structure is used to produce income.desoibe the use and portion
of the property sea zed to produce income.
RG -/8- 3G- Yoo - 000 . gy 9 -009
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Saa.Canty,and Township • Is claimant vamtng a homestead?
❑ Yes ❑ No
Si: ..non• da.ara
I hereby certify the above statements are true,correct,and complete. / //�J['/A
Address of contact(number and meet.abr u .e,end ZIP code) e of vara' �L,p.e•iy(number and smear osy rare,and ZIPmde)ai
y/ _ ,'�� ASSESSOR ONLY
AG65�9 I A�SEVALUE111I HOMESTEAD VALUE I VALUE
NON-RESIOENTUIL
Land not exceeding one(1)acre immediately I(t) '
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) 1(3)
Residential improvements or Dwelling I(e)
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. SgraSrre of Assessor Date signed(month,day,year)
and complete.
Venfy'ug action-Signature of Ad:tor Date----ned(month,day.year)
' I I l'.
.. cam z - .- x.=STANDARODEDUCTIONALLOWANCE ';- - '-)±{; ;ah.44.S - ,-.1_-2
20 pay 20 Lesser of 60%of the assessed value of the homestead or 565,000
Abtnithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile lame $ JUL 2 2015
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1)2)of the assessed value of the mobile home or manufactured home.
Sigaa of AddaNddor Date si month de yea
?Pf'YYLiCki_, CI8SnNwIhCOUNTY AUDITuR
DISTRIBUTION: Original-Cour .yAW.ta,Fie-Samped Copy•Taxpayer