Homestead_Ingler (2) "",o CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
-A STANDARD / SUPPLEMENTAL DEDUCTION
' '' State Form 5473(R15/5-14)
HC10
�e- Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone, Social Security, driver's license, state identification and federal identification numbers are confidential ..• 6-1.1-12-37.
. . ' • ,.Z 7�s9i�-e• .. :'._.... ''= ;'CERTIFIC'ATION STATEMENT :::7-2;7 - -_ •_ _ _ - •
I (We)/44424...-1J �4- 4 • _y'��')l certify that l (we occuple.-- 1,cipal
place of residence or am (are)buying the following described real prop'rty under contract for which a HomesteMSrispertx Tax Standard
Deduction is hereby claimed on the date this application is signed, (date o f af(J )1Ot&Ve):
❑ Own. ❑ Am (are) buying under recorded contract. a
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ( MC —
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a gL�f )&r NTrYsRtia)ITO$t.
❑ Am (are) the shareholder, partner, or member of the entity that owns the property.
+-.,-.
--)
-
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
..,''r „L ;r •' `PROPERTY,DESCRIPTION _ ' • T'- .. • _
County Township Taxing istrict(city,town,township
Parcel number 1 Legal description )j•d J/ Is the property in question:
p�terfutil ," / ❑ Real property ❑ Annually assessed mobile home(IC 64.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
.1.6, - a3 - /‘, _ coo - 00 z . 495- - 0 )4'
'per u:::1'&t: _ _. -, . ' , pROPERTY0VIrNEI5 ELSEWHERE BY CLAIMANT.j - .. - . • ._
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
gn re f claimant
///I hereby certify the above statements are true, correct, and complete. X
Address of contact(number and street,city,state,and ZIP code) IA dress of vacated homeste if any(number and street,city,state,and ZIP code)
)5 4 i r�,n G f sl«d</N 9 35.
_ S SE : I NON-RESIDENTIAL- _
ASSESSOR USE ONLY,., ASSESSED VALUE 1 HOMESTEAD VALUE- VALUE
Land not exceeding one(1)acre immediately -
surrounding residential improvements (1)
Other 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) I
Total value (line 3 pits line 7) (8) I
I hereby certify the above is true,correct, I Signature of Assessor I Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
•yi 4 i ariiy�, _ _ ,, -• .STANDARD_DEDUCTION ALLOWANC_E___ _ ' .' _ _ � '
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 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(1!2)of the assessed value of the mobile home or manufactured home.
ISignature of \ Date signed(month,day,year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer