HomeMy WebLinkAboutHomestead_Tichenor (6) flCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD I SUPPLEMENTAL DEDUCTION
state Form 5473(R15 1 514) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. i
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37 r l 1
---, ";- CERTIFICATION STATEMENT -
I(We)�`, LlW4(Pr��/ certify that I(we)occupied as my(our)prindpa• b
place of residence or am(are)b ^g e following described real property under contract for which a Homestead Property Tax�c and
Deduction is hereby chimed o/�e date this application is signed. (date of signature). I(We 1 p a
Own. ❑ Am(are)buying under recorded contract. O 015
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. G ',
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified person tajhd v- PITear m d
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. �B UN 7, oiia
- <-,-- -
t•buying on contraa.Fee Simple comers name]
Recordefs o6ce where contract is recorded Record number Page
Coen•C/ 610 Towmship sit Ta-tg n (OtyJmvn,township
U
Parcel number /V�Jw L a esaip:iat y Iis�t eprrfperty I,questal:
A y/ / F Real Mogan ❑Annualy assessed mobee home(IC 61.1-TI
lf any po�!t of the residential stru re or the land note ceedi g me(1) Nat it ndiately citmwds that structure a used to produrn'vmme,desmbe the use and porton
of the.�p/rdddbbbeeerrr'. uted to prods incorce,
pXo-/)'02410 _ rat 7&J -6a,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
SYa:.County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature of ant
I hereby certify the above statements are true,correct,and complete. _
//////,,'�����' Address of contact(number and s.(eet.dcy stare,end ZIP code , Add of vacated ,d any(number and street,oty,gate,and LP code)
ASSESSOR USE�rwnC�t' ASSESSED VALUE I HOMESTEAD VALUE I VALUE
NONRESIDENTIAL
Land not exceeding one(1)acre immediately Ill)
surrounding residential improvements
Other land I(2)
Total land(line I plus line 2) (3) I
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
_ Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (fine 3 plus line 7) (8) I
I hereby certify the above is true,correct. Signature of Assessor ID=signed(monat day,year)
and complete.
1 y9 action-St re of ; r Date signed(nmac day,year)
rte" ,-::.-_: r_ „ —_"'STANDARD DEDUCTION ALLOWANCE:_ .may.: =>; _ -._i77i;-
20 pay 20 - Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
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.
1 sgr ahie of Pudmor Date signed(ro'L•r,day yea)
DISTRIBUTION: Ongvol-Cony Atator,Fie-Samped Copy-Taxpayer