Homestead_Frederick (3) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
- 71111
a_^`� \ STANDARD I SUPPLEMENTAL DEDUCTION FORM
• ( Sate Form 5473(R15I 5-14) HC70
'. Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for(ding insfirctions.
NOTE-Telephone,Social Security,drivers license,slate identification and federal identification numbers are confidential under IC 6-V 1-12-37.
' - - ' - - - - CERTIFICATION STATEMENT '. -' '"'� w - _-T- ^-"
I(We) s�•¢V -e Jl
.O Fre L°/'/Ii's certify that I(we) IT. 11
place of residence or am(are)buying the following described real property under contract for which a Ho '- tea•'- •• •T-1 fi near.
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
cPawn. ❑ Am(are)buying under recorded contract. JAN 5 2016
❑ 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 qualified pe . al reside ce e
CI Am (are)the shareholder, partner, or member of the entity that owns the property. i, , r/W101
' -- =..
.-''
If br g on send.Fee Simple owneds name
I
Recorder's o5ce where contract S n++,da,l Record number 1 Page
•
_ - � -i.-- -r C.:=s'-"- ._ =-_PROPERTY DESCRIPTION`"" _... _ *- ;.:-_
County 1 Towrmh p Taxing disthct(city,form,townshp) �
1
Parcel rvanb Legal desmction Is the property in qsrestaxr ,
gReal property ❑ Amery assessed moth home(IC 6-1.1-7)
If any portion of the residential soudure or the land not exceeding one(I)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property tf3ized to produce income_
2. 6 - 0 a - './ 9 - /0 / _00o / 3a -0/ 9 ,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate.Court',and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signatur of daimam
I hereby certify the above statements are true,correct,and complete. X ." �! • /
Address of m,tad(number and street,aly.state.and ZIP code) Address of vacated homiest - -ny(number end street.thy,Yale.and ZIP code)
//d Sul o K sr. HAUErot/ ((Zile
Land not exceeding one(1)acre Immediately (1)
surrounding residential Improvements
Other land (2)
Total land(line I plus line 2) (3)
Residential improvements or Dwelling I(4) I
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6) .
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct. Signature of Assessor Date signed(month,defy year)
and complete.
Verdying aCUn-Signature of Auditor Date signed(month,day year)
c� i ?o:'» - _z_4741..... st^ rr=`a ST AND ARD DEDUCTION ALLOWANCES_, ._°r-t2u -=?.-
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home float is not aswc•ed as real property may
not exceed one-half(l,2)of the assessed value of the mobile homee or manufactured horse
Sigl flA .\11,e!� Tt 4J/• Da/Odom.---debt Year)
DISTRIBUTION: Orgial-Gassy AWdor.FieSamped Copy-Taxpayer