Homestead_Grubb �":' CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR I
:e__-y ,T STANDARD/SUPPLEMENTAL DEDUCTION HOROM /� /�
i'� Sate Form 5a73(R1515-14) //
\._l Prescribed by the Deparnent of Local Government Finance
!!!
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Severity,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
v- - 'f CERTIFICATION STATEMENT • . ' - •. ' - -f !--r - -
1 �
I(We) - �' liffi \L!�RIirr11 6 certify that 1(we)pcC t a m our)WO"
place of residence or a (are)buying the following described real property under contract for which a HomesP Ta
Deduction is hereby claimed on the date this application is signed. (date aaa ign , e
n. ❑ Am(are)buying under recorded contract.
JAN Al C
C O�
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. JHI7 J U
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. 1
If toying on contract,Fee Simple owners name
Recorders o5ce where Gvntrad is recorded Record number 1 Page
it T _ -,_- .t- r a ._ __s-'-b__ -: 'a PROPERTYDESCRIPTION'r "`�' t L n'&.W.dr- ,:T-:
County Township Taxing district(aOt town,township) r.1 _ _.• ••
Panel number legal description Is the progeny in auesdort
❑Real property ❑Annually assessed mobile name(IC 6-1.1-7)
If any portion of the residerval sbudure or the land not exceeds g one(I)acre that'immediately surrounds that srudure is used to produce produce income,describe the use and potion
of the popery razed to poduce income. I
PROPERTY OWNED ELSEWHERE BY CLAIMANT
1 Stns,County,and Towns.-ip Is claimant vacating a homestead?
❑ Yes ❑ No I
Sgna ae of davnam /�
I hereby certify the above statements are true,correct,and complete. /�j a a` -A , l ) V
Address of dprad(number erg street ty,Sate,and ZIP code) Address of vacatedR..z.:ead.d any(number and�Cleatt-WY.state,and ZlPmde)1
05 E So S ak.JmDt zAf` +40
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)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total Improvements(line 0 through line 6) I(7)
Total value (line 3 pits line 7) I(8) •
I hereby certify the above is true,correct, I Signature of Assessor Date signed(month,day,year)
and complete.
Vei(yig action-Signature of Auditor Dame signed(nerat da%Year)
-4...-..-1.1;-;:s±: _� _-..emu _ —
',V.:=.--4.;r:7-'f.-�-�. � -�=--�i STANDARD DEDUCTION ALLOWANCEr-c���'Y�.�� ` _ -
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding 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 exceed one-half(12)of the assessed value of the mobile home or manufactured home.
c /1P Date signed day,stead
or
DISTRIBUTION: Ong:al-Co:nty AUd or,Fie- tamped Copy-Taxpayer