Homestead_Moore 7-"^k CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
r STANDARD!SUPPLEMENTAL DEDUCTION
Save Form 5473(R151 S1<) HC10
� �' Presmbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse spe for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confide y i•i: , .1-1 AIL
■�a -►CERTIFICATION slATEMFNt— - - ^ - IJ•-.1' - '`r' i I -
1(We) IfJAE ( ,tfii!W Pi P -rlify that) -). !.a ! -.i ..r). I
place of residenr-or am(are)buying the following des a-• real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date11 U Ecntre).2�:
ID Own. ❑ Am(are)buying under recorded contract. CC GG
❑ Afn (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. /j
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified I trust.
- ❑ Am(are)the shareholder, partner, or member of the entity that owns the property. •N COUNTY AUDITO
__ _ ,. ;;
»
L'buying on conoact,Fee Simple owner's name
Recorder's obce where mn.Yac is recorded Record number Page
I
'N> " -4- ,4.PROPERTY DESCRIPTON?'- �- -� 0" •c
County O: Township Taxing district(oby tvavi -4)
Prel earthy X6)-04--X I Oct-000.3&-0 I
dO Is the property property in rtesaan
❑Real propeM ❑ Annually assessed noble home(IC 6t.1-7)
It and portion of the rn vntal=mute or the land not exceedxg one(1)acre that immediately surrounds that suu:ure a used to produce income,aesolbe the use and portico
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sax,County.and Township - Is claimant vacating a homestead?
❑ Yes ❑ No
I Sigpa:tar`of claimant I hereby certify the above statements are true,correct,and complete. 1/ kc It “,10 ran -Q
!Address�Ot(rlumber and=wt..,..state,and ZIP code) • �t%KQTU of vacated ho. ead,d any(number and sree. ` 5��ate.and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line I plus line 2) (3) I
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage 15)
Other improvements (6)
Total improvements(line 4 through line 6) (1)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Sgnahi:e of Assessor Date signed(rnpxh day,ysa)
and complete.
•
Veyig action-Signature of Factor 1 j Orsy.�(rmAm.{�y.l""`) I -I{
11NIL 16NLJ, /E ' 5L 1 n
T
�' '.3-"Via:'=" _�1�- ,;v�-s_�-,��STANDARD DEDUCTION ALLOWANCE�n" - .�;�M- .�'.'-�"q.;`� +�3,�=`
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000 DEC 9 2015 PAV
NoNsthslanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not es one-half(12)o(the assessed value of the mobile home or manufactured home.
Signets i Odw / / rea
0 4 Li It c1/f Lti) 11 ,\ GIBS N CSNT� 1410r 5
DISTRIBUTION: Original Carry Aud;tor,Fla-camped Copy-g]'+Wyer Vvl lJ
:�^ CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD / SUPPLEMENTAL DEDUCTION
Sa:eFOrtnSa]3(R15/&14) '
�� PresaiEeO try Nx DepaMrent oi Loal Ga+emmmt Finance
FORM YEAR
HC10
INSTRUC710N5: See 2varse sitle lar �ling inslrucfians. `
NOTE: 7e/ephrne, Sotial Sewnry, drivefs ticense, 9ate itlenfifice(ion aM fede2l idenlificauon numbers a2 con:ide "' .7-7
I(We) rtify that I ) � r) pal ��
place of residen or am (are) buying the follovring des real property under conVaa for which a Homestead Property Tax Siantlard
Deduction is hereby tlaimed on the da:e Ws applicauon is signed, (dafe�p(� n rc). �yf� �
UCG � ZUIJ'
❑ O�m. ❑ Am (are) buying under recorded conVaa.
❑ Am (are) enutled ro occupy as a tenant-stockholtler of a cooperative housing corporation.
i
❑ Have a benefcial interest in the Wst or the right to occupy the property under the�tertns of a qualif wst.
❑ Am (are) the shareholder, partner, or member of ihe entiry Nat owns the pmperty. �
COUNTY AUDITOq
ReouEe(z o3rn xirere mn•vaq is mmNed Remry nwr.Eer Page I
Cam:y Taxrste0 , iatin9 Oa•,M (ary' :own x -) �� I
P rzlnivnEe LepalEesaiaion IISUieyopertYNQUes:m �
� 1 D ho _O dfl ❑ Real pope .ry ❑ nrnuary asusua mooie nome (IC S�.t-l�
'L (l r
p�^Y Ca'+an W Ne rtsiCem.ial zT�c�rte w ttie UM wt es¢cC�mp me 11) ace ttut r�xEU:eN wrtountls Vat s•vucture ¢ wN m P�'� vcaae. CemEe me uu aM W�'.ian
m me woxm v.�ZeE m aoa�m �wma. I
�'�• �Y. � T��c ' Is tlaimant vaaling a homestead i
❑ Yes 0 No
:ae d aainam � I
I I hereby certify the above statemenis are we, cortect, and mmple;e. � .!� r�n
�L�� �
ACC�ess W mTad ( eM sfreet Yab. erd LPmCe) PGtlres ol vao'aC M. es:eaC. d aery (manGer and stee[ . ia'e. arMLPwEe)
60�� . c� C�, �fil� I I
Land not ezcaoCin9 ona 1�) acre immeaiatey lt) I '
surtoundin reslAentlallm rovemenb
ONer IanC (2) I
Todl IanE (line 1 plus line 2) (3) I �
ResiEenUal improvertrenn ar Dweliing (<) I �
Annualty AuessaE Mobile I I .
Manufacturad Home Gange (5)
OIIier(mprovemen6 (6) ' �
Todl improvemenb (Ilne a fhrough line b7 (7) I
Total value (line ] pl(a line l) (B) I
I hereby ceRify the above is We, correc4 59�� MASSessa Da:e signel(rtvClt �ay, yxd�
antl complete. '
Vm!)'vg actiom SynaLre o1PW::ar O e :b, ,� -
20 _ pay 20 _ Lesserof 60% of fie assessed vAUe ot Ne homes:ead or 545,000 D E C 9 C � �5 !
AbMi:hzanding any ofhe�pmvivon, (he wm ol the deducfions provitled in IC 6-1. f42 to a moblle hwne 5 �
Nat is rmf assessetl as raal property or to a manufaGUretl horrre J+at is rrof assessetl as real properry may
rrof es one-hall (1/1) of the essesseE value of Ne mobde Aome ormanu(acfu�ed home. '
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GIBS N C H���
DISTRIBUTION:pghal-COUn.yNd�.:ar,Filo-SampMCopy- yer � ,