Homestead_Harrison (2) 43 °` CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR
•;a_ ' •
STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(Ri5/5-14) HC10
• Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Seventy,driver's license,state identification and federal identification numbers am confiden r •- tY1 12- t )__
•CERTIFICATION STATEMENT` -
I(We) r PIPIIIIIPrff•' L �_._s certify that l( ` . y i. .i�I
place of resi•ence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date oeterfhy91 2D15
❑ Own. ❑ Am(are)buying under recorded contract. 11 -
❑ 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 qualif trust.
❑ Am(are)the shareholder, partner, or member of the entity hat owns the property. NCOUNTY AUDITOR
_? _.'
II buying on contact,Fee Simple owner's name - _ _ - - �. ...._.
Recorders otSce where contact is recorded Record number Page
..�. - v '' '-4,"• r =e. PROPERTY DESCRIPTION-3.5.2_ -— s` _4—.- . L.c•
County Township Taxing district • ,Wpm township) • e
Parcel number Legal description /T C Is the property in question:
/7 u t,_7 3Y- a -9 ❑Real property ❑Annually assessed mobae borne(IC 6-1.1-7)
If any parson of the residential structure or me land not exceeding one(1)acre that immediately sunounds that smuciute is used to produce income,describe the use and portion
of Me property td&ed to produce income.
a l t — /3 _3 y - /0 0 _ too . cl 14" - oa f
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sae,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature of clamant
I hereby certify the above statements are true,correct,and complete. ,k, a A h k3 �nSOIA-
/Address of contact(number and street,ray,stag,and ZIP code) Address of vacated homestead,d any(number end towel,city sate,and ZIP code)
'\ 3�yy S x,50 E Carta Ad CI IN
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (t)
surrounding residential Improvements
IOther 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)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(monm,day,year)
and complete.
Vaindg action-Signature cf Author Date signed(Hamra.day,year)
st _ =_�` _ _ _--zen" .STANDARD DEDUCTIONALLOWANCES 2-s`P + t =._
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Aohethstanding 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(12)of the assessed value of the mobile home or manufactu home.
Sigratn of Dud:_ Date signed(moron day,year)
DISTRIBUTION: Ongi'al-County Audaor,HeSamped Copy-Taxpayer