Homestead_Morrison (10) `_.' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
..1 STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Fam 5173(R15/5-14) HC10
Prestnbed by the Department of local Government Finance
INSTRUCTIONS:See reverse side for tiling instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers ere confidential under 1C 6-1.1-12-37.
- - - ' CERTIFICATION STATEMENT 7 ' r-• - -
I(We) o—"_-° = -t - certi fy that I(we)occupied as my(our)principal
place of reside ce or am(are !lowing described real property under contract for which a Homestead Property Tax Standard
Deduction is here y claimed on the date this application is signed, (date of signature). I(We):
❑ 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.
mers name 'I'
.- -- -'7,..:.--0:.-.4' .+ . c=- ..
Recorders°M where contract is recorded Record number Page -
ce
ej' - =+ a=77:PROPERTY DESCRIPTION fr, .i / is-R .i. t _ 3-.__':i
Carty Tcwnstip Taring disoict(city, -wit nip)
1.01
Parcel number Legal description�j ps Is the property in question:
ar0 • L —e-1 b b-. bb a e `J❑ - eat property ❑Annuaey assessed mobie home(IC Bl.l-7)
If any portion of the residential sT.sure a the land not exceeding one(1)acre oat iatety surround[[[s that siru.=is used to produce income,describe the use and peracn
of the pmpeny uli¢ed to produce income.
C?; i — L0-7 Z — o" A 14
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,Cooly,and Toxnstuo Is claimant vacating a homestead?
❑ Yes ❑ No
Signature daimam
I hereby certify the above statements are true,correct,and complete. 177///1 �
Address of contact(number and street,aly,state,and ZIP code) 1 I 6 Yl Address of vacated homestead,I try(number street oty,state,and ZIP code)
� , 6
it .'78b. , ' 'A. . ui!
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential Improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(line 4 through line 6) (7) l+
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Dare signed(month,day,year)
and complete.
V yi g action-Signature of And::o Date signed(month,day,year)
- ,-.?KT STANDARD DEDUCTION ALLOWANCE' S-71-
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Nohsithstanding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home $
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not exceed one-half(112)of the assessed value of the mobile home or manufactured home.
Sgnatae of Aug- Date gs- (rtaCn,day.year)
.IL SR
DISTRIBUTION:Original-County And',FeeSamped Copy-Taxpayer