Homestead_Sprinkle (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-a STANDARD/SUPPLEMENTAL DEDUCTION FORM
Megr T 1 State Form 5473(R15 1 5-14) HC10
Prescribed by the Department of Local Goverment Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1- d
I(We) (2 certify that I(we)occupied as , (our)principal
place of residence or am(are)buying the following d abed real property under contract for which a Homestead Property Tax StaQpdrarQ 2016
Deduction is hereby claimed on the date this application is signed, (date of signature). I(WjA N 4
IziOwn. ❑ Am(are)buying under recorded contract. .
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. airtM0f
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residen.1-' f TY AUDITOR
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. GIBBON CO,O
— ._•._ —:-_ •
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Recor'..efs oece where contract is recorded Record number Page
:-�. ;;; t.-7'a= c:PROPERTY DESCRIPTION S._=S ._ —i'r- >M_.' .s -=-a
Cony TownsNp Taxing dlbid dry,town,tonnsh9)
Parcel number Legal desorption Is the property in question
❑Real poetry 0 A1lnuaey assessed mobile home(IC 6-1.1-7)
If any portion of the residential=aura or the land not exceedng one(1)acre that immediately surrounds drat snulure S used to produce Income,desaibe the use and por'.ion
of eye property Waxed to produce Income.
) — lad 8- lot- ooaa 1a 8- 0028 i
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sat,Crory.and Township Is claimant vacating a homestead?
0 Yes 0 No
Signature of da'unam
I hereby certify the above statements are true,correct,and complete. �I� / /J
_LjJ //ILA .C� a l
Address of contact(number end street city.scat tZIPcode) dress of vacated haneste ,d a..f(number and steel.ply,slate,and ZIP code)
WS A O 5, /, r t/ _ ■ ., . • i
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(1)acre Immediately I
surrounding residential improvements
I
Other land (2)
Total land(line 1 plus line 2) I(3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) I
Other Improvements (6)
Total improvements(line 4 through line 6) (7) I
. Total value (line 3 plus line 7) (8) • I
I hereby certify the above is true,correct, Signature of Assessor Date signed(r:mm,day,year)
and complete.
Ves`rig action-Signature of Auditor Date signed(month,day,year)
it't_ x .' STANDARD DEDUCTION ALLOWANCE F--,r-' `- `z mom' -.s Z-t'-,Y---LAS
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 $
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home o`meo'rmanufactured home.
Sign a. LL/ Date signed(cooled*Sari
DISTRIBUTION: Orgnal-Caney Aid.tor,Fie-tamped Copy-Taxpayer