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, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
� - STANDARD I SUPPLEMENTAL DEDUCTION FORM
'� State Fenn 5473(R15/S14) HCTO
Prescribed by the Depatnent a Local Gwesrrtem Finance
INSTRUCTIONS:See reverse side for(Eng instructions.
NOTE:Telephone,Social Security,duvets license,state idenfacation and federalIdentfcation numbers are confidential under IC 6-1.1-12-37.
I(We) - mil I'Li . certify that l(!e •.•dpi= asm '•• )pI I,
place of resi•'-nce or am(are)buying the folio.'ng described real p•perty under contract for which . s•me `` -.--r --
Deduction is hereby dawned on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract FEB 4 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 qualitie• rsonal r-siden-- trus .
ID Am(are)the shareholder, partner, or member of the entity that owns the property. _L
::-
'�-^ -
d buying on contact,Fee Simple owner's name
Recorder's o5ce where contract is recorded Record number Page
3 x7 .3 PROPERTY.DESCRIP.TTIO ? ita it ta
County Township Thing,'.( )
'
Parcel number Legal l description �t 5.a ,,0 4 Is the property in question:
Pr SF Ar / -fi ❑Real property ❑Pmusy assessed mobile home(JO bt.t-n
If any portion of the resides-1W si=te or the land not esceed:^g one(1)acre that immediately sunwmds that drucbae is used to produce income,describe the use and portion
of the,.u,...y imbed to produce income.
act - 0Y- a 5 - f-1o0 - 000 - Co 30 - o ?-O
" PROPERTY OWNEDECSEWHEREBYGLAIMANT: _r.
State,Carry,and Towratip Is claimant vacating a homestead?
. • �0 Yes ❑ NN0
I hereby certify the above statements are true,correct,and complete. '5 � y ` ' J,/ !I
Address arm s(numberend.scet�:ea:e,end vPcode) ssofsofvace ted/((.•.•CCtaresea(iJ//)any(number aim )treeet aft tae,and ZIP code)
"113 S pad , I+J 4 1�u �
. • ASSESSOR USE ONLY • r , 1 ASSESSED VALUE' .1 HOMESTEAD VALUE ' 'I . " NON-RESIDENTIAL :
. .
Land not exceeding one(1)acre Immediately I(1) - --,-.,re.-
surrounding residential improvements _._ --_
-A-T-r.ter . t,•Other land (2) _> a UA.
Total land(line f plus line 2) (3) -
Residential improvements or Dwelling (4) F
Annually Assessed Mobile l -
-
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 ofA•e.vor Date signed(month,day,year)
and complete.
Verifying action-Signature of Ruthtor Date signed(month,day.year)
r
.!ddb.. - t(C;_1'-' STANDARD DEDUCTIONrALL'OWANCEGTS-?eihyrf�- -d
20_ pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notxithstandi g 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 or manufactured home.
Signature a7d- -,2.,14;`C I oare signed(mansl,daY.reed
DISTRIBUTION:Original-Ccureyk,dmor,FlcSamped Copy-Taxpayer