HomeMy WebLinkAboutHomestead_Loveless (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
ri._.--;S STANDARD I SUPPLEMENTAL DEDUCTION
tSate Form 5473(R15/5-14) HC 70
Presobed by Lie Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. I I
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1 l- 7. Dglpp
CERTIFICATION STATEMENT
I(We) I : - a a - - _ certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property 1 ( ngard 2015
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We)-
❑ Own. ❑ Am(are)buying under recorded contract. o
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. I • �IrMIh f
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pers8SetliteCI INT -AUDITOR
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
_ _ - .
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number I Page
: `•, -" b-s p. .?. ,._.PROPERTY.DESCRIPTIONIt `-?- _ " 14._ .1,
C •y Township Tang district(Sty,tam,tamahy)
Parcel number Legal desoiption Is the property in question
❑Real property ❑ Annually assessed moble home(IC 6-1.1-7)
If any perbo of the residential staeae or the land not exceedog one(I)acre that immediately surrounds Nat structure is used to produce income,describe the use and peon
of me properly visaed to produce income.
2 ICI- al - 3a - 303 - 700 . 6 64/ - Co/
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Save,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
eX
Signature of m
I hereby certify the above statements are true,correct,and complete. k - V
e. jr Address of cordad(number and seeet ply,state,and ZIP code) Address of vacated homestead,d any(nu end street aty Sate.and ZIP tide)
4267/ g /OZJ S Of 124ez 0C'1% A/%17 Lie
Land not exceeding one(1)acre Immediately I(1)
surrounding residential improvements
Other land 1(2)
Total land(line 1 plus line 2) I(3)
Residential Improvements or Dwelling I(4) I
Annually Assessed Mobile I
Manufactured Home Garage I(5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pies line 7) (8)
I hereby certify the above is true,correct,
I Signature of Assessor Date signed(month,day,year)
and complete.
Ve-dyig adorn-Signature cf Ad.tor Date signed(month.day,year)
u 7� a . r_STANDARD,DEDUCTIONALLOWANCE='t Z , i: _ -1 i!
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other prevision,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 mat property may
not exceed one-half(12)of the assessed value of the mobile home or manufacture
Sgnahm of Am .• t... Date signed(melds,day.year)
` f iL� /m /0 ' 7 -4.5
DISTRIBUTION: Ongaal-County Ateilor,FIt- tamped Copy-Taxpayer