HomeMy WebLinkAboutHomestead_Maynard CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
• Sate Form 5473(R15/5-14) HCI O
Presmbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. I
NOTE:Telephone,Social Secunty,driver's license,state identi:ication and federal identification numbers are confidential under IC 6-1.1 12 37 -
- ' p - CERTIFICATION STATEMENT - -' '
I(We) 7/SA jA awn t �r /, .ti' certify that I(we)occupied as my(our)pOep�l iil
place of resid-nce or am(are)buying the following de- -•real property under contract for which a Homestead Property Tax Standard4 Q 2015
Deduction is hereby claimed on the date this applicat••is signed. (date of signature). I(We J
❑ Own. ❑ Am(are)buying under recorded contract. (�` ei • i
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. SON C vsemvey
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❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence tti�Nry
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. I -Ivan- R
__-'• _ - __ "
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if buyirg on cocoaq+Fee Simple camera name
Recorders otbce where contract is recorded I Record number 1 Page
i•Y _,;Y, - D---y t; g PROPERTY DESCRIPTION: =� .fib:: ,+ e_> .:1ea':- -_ S
a _ dim n ,_!'
Pa. tuber Legal description I Iy the popery in question: /
�Real property ❑ Amua!y assessed moue borne(IC 61.:-7j
It any;urban of the residential savcure or the land not exceeding one(1)acre that' ...ely surrounds that structure is used to produce income.desmbe the use and portion
of the property vd¢ed to produce memos.
d‘-/9J0?/G/- O00. j5-0Z- 6C"V
PROPERTY OWNED ELSEWHERE BY CLAIMANT
1 Save,County,and TowrlSNp Is claimant vacating a homestead?
❑ Yes ❑ No
Signature j Loam
I hereby certify the above statements are true,correct,and complete.
x(0/irdhell vr/44i4(tori.
Address of=tad(number and=eel,My,state,and ZIP code) Address of Vacated homestead,d any(number sheet.ray,sate,and ZIP code)
I I _ '-IS- I ow _ a ,' ii •
/ ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON yESISIDENTIAL
Land not exceeding one(1)acre immediately (1)
surrounding residential Improvements
Other land (2)
Total land(line f plus line 2) (3)
Residential improvements or Dwelling (a)
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, I Signature of Assess« Date signed(month,day,year)
and complete.
Venfyig action-Signature of Auditor Date signed(mornth day,year)
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