Homestead_Carr - CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
cffi__. - \\ FORM STANDARD/SUPPLEMENTAL DEDUCTION HOTD
State Form 5473(R15/5.14)
5' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructkos.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential u ••r IC 6.1.1-12-37.
- - CERTIFICATION STATEMENT - ,•t_ .. __'1 "�" -` -
I(We) I - _ �_i ,� certify that I(we)•:. pi-?as j •u ,pn ••;. .
place of re-,dente or am(are)buying the following described real property under contract for which a Homestead Property ,�•r
P ( ) uY 9 9 P party party Tax '. •a •
Deduction is hereby claimed on the date this application is signed, (date of SigpEtr l e):
❑ Own. ❑ Am(are)buying under recorded contract. 92015
❑ 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 al resi rice
E l Am(are)the shareholder, partner, or member of the entity that owns the property.
R
If buying on contract,Fee Simple ceners name
Recorders o3(where(=tract is recorded 1 Record number Page
Canty Township Taxing di - (city,town,I .)
Parcel number Legal densai{4bn�n/ I Is the property in question:
V y&/ � /3,104---0 Real ooperty ❑ Annually assessed mobile home(IC 6-1.1-7)
If any paten of the residential sTCUe or the land not esceedig one(1)arse that immediately surrounds that sbucure is used to produce income,desanbe the use and Paton
of the property utilized to produce income.
A62 ../. — ° 7 -. /o ,)-. — Colt / 7Cr, - o },e
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
-, m of clamant
I hereby certify the above statements are true,correct,and complete y C.efr'`'t—
Address of corded(number and street,rdy,slate,and ZIP code) c Ad-0-1 vacated homestead,2 any(number and Sleet(y,state,and ZIP code)
7 iv, ,Jo Sr Pnwcc.ixi 4(7 d
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(1)acre immediately I(1) I
surrounding residential improvements
Other land I(2)
Total land(line 1 plus line 2) 1(3) I
Residential improvements or Dwelling I(4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total Improvements(line d through line 6) 1(7) I
Total value (line 3 plus line 7) I(6)
I hereby certify the above is true.correct, Signature of Assessor Date signed(month,day,year)
and complete.
Vedyi g arson-Signature of And:ta Date signed(rmrth,day.year)
?". —7 y <STANDARD DEDUCTION ALLOWANCE -e�'L`.5y1- ;.( 5:=yam•'•
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545.000
Nohhthstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
that is not assessed as real property or to a manufactured home that is not assessed as real properly may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured hone.
Sgta^te o4 , ,asin (jtej Date signed(math,day.year)
DISTRIBUTION: Ongial-County Ardito,File-Samped Copy-Taxpayer