Homestead_Vanmeter .tae - CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
tFORM+° STANDARD/SUPPLEMENTAL DEDUCTION
ri - State Form 5473(R15/5-14) HCID
Prescribed Sed by the Depane0l loml Government Finance
INSTRUCTIONS:See reverse side for7Lrg msmuc'xrts u l y
NOTE:Telephone,Social Severity,driver's license,state identification and federal identification numbers are confiential under IC 6-1.1-12
': '7-'7717/_ -7._ce. -' , CERTIFICATION STATEMENT : 1 '=`.�
7.-,r
I(We) A� to i ry f.- � certify that I(we)occupied as my(ouc(g>1ip7al'
place of residence or..All(are)buying the following described real property under contract for which a Homestead Property Tax S`tsM dJ1 1�
Deduction is hereby. t ell on the date this application is signed, (date of signature). I(We): ���U
❑ Am(are)buying under recorded contract Gle ' , •
(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. SO n 71 yJ
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residenQE4/ p'y -'
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. (/OITOR
.
If toying on contact,Fee Simple owner's name
'Recorders o5ce where corGad is recorded Record number 1 Page
a'`ll» -1=1/ar eBl RROPFRTYDESCRIROON::i
Cam:y / Township Tang (ory,town )
-/ 0
Parts .
Legal desaipton Is the PertY in GussSOn:
07Z'do-Oa-olo/- �oO.20/-oo/ propaalY ❑Annually assesxd motile Mme(/C 6,.,-J)
If any portion of the residential s't�.ae or the Land not exceed g one(1)acre that i:nada:Sy that sb-,tsn is used to podure inmae,describe the use and potion
of the property strived to podnre Larne.
. •. _ - PROPERTY_OWNED_ELSEWHERE BY CLAIMANT _- _ - , -
Ga=.Casey.and Temisp Is claimant vacating a homestead?
. ' ❑ Yes ❑ No
I hereby certify the above statements are true,correct,and complete. JJ'�/aiare I�/s `//Z/G/
Address of contact(number and street coy,Sete,and ZIP nude) Address of vacated 1toLYSend,d any(number and street,ary,state,and ZIP code)
3 Sow-_ /02.St U'.Q/7/-f t22 9 -.. ' 4e
• ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE ' I' NON-RESIDENTIAL
. VALUE
Land not exceeding one(1)acre Immediately
surroundingresidentialImprovement I(I) _ _",zi_, ;.TSu__
Other land (2)
Total land(line I plus line 2) (3) . _ — •
Residential Improvements or Dwelling (4) `j _+ •
Annually Assessed Mobile/
Manufactured Home Garage I(6) - I T 3?'. 1,_'
Other improvement (6) °^-- i
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
I hereby certify the above is true,correct, I Signature ofA•ses<-r Date signed(month.day,year) —
and complete.
VSYy"eg action-5gnabne ofAUCtx Date signed(math,day,year)
'Jr i'. Stara==.'w'^OSx`—T -I,STANDARDDEDUGTION'ALLOWANCE . =_n;
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 6-7.1-12 to a mobile home $
that is not assessed as real properly or to a manufactured home that is not assessed as mar pmpe try may
not exceed one-had(1:2)of the accessed value or the mobile home or manufactured home.
Signature of Auddor Date signed(meek day,year)
DISTRIBUTION:Original-County Aud:tor.Fie-Stamped Copy-Tax aver