Homestead_Neibert (2) ' '. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR 1 I
-A_ = STANDARD/SUPPLEMENTAL DEDUCTION FORM - 1
11. State Form 5473(R15/5714) 1 \ , 11010 I^ y
i Prescribed by the Department of Local Govern anent Finance 11T111 I U( 11
INSTRUCTIONS:See reverse side for filing instructions. `
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.•7- ///1; /...7�1.�_••/ • PM CERTISICATICN STATEMENT '7'-`.' ' - ? I I .),- -. t'r
• I(We) -i/'//)7C7/L '� ` certify that l(we) led m j o .gin 11 �
place of residence or am(-le)buying the follows g described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of sgnjle1 t jl'U):2015
Cl Own. • ❑ Am(are)buying under recorded contract. AA j
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❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ""
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pers residen
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. �(
, .- - _ "
- r-. i . _ i-. :.�...._'_'t
II buying on canted.Fee Simple owners name
: Recorder's f o ice where mr ac1 is recorded Read number Page
�Y/\ k r h..74-. Y -_tea;_.__,PROPERTY DESCRIPTION,;�e'%1 = -= 4liir v__ -.
pot,: ber Legal des-motion r II- proPerry - /
' 6/51 , 'J ❑Real.. y r �, assessed mo[L borne(106-1.1-7)
If any/coondthe residental s}uC eor the land not ez eda,gone(1)acre th4JTM�-ed•'K uMSttut a/mo re S -- to prod•.. aesmbe the use and pardon
• of the property wined to produce income,
G(1/
ac- /8—OS — 900- 705. 30-7-0;. /
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,Cour»y,and Township Is daimant vacating a homestead? 1
- ❑ Yes ❑ No
Signets davn�nt ( >/
I hereby certify the above statements are true,correct,and complete. / !/J%
�0/��/
/� , Maness of mrxad(number and street air 9%e.and ZIP Cade) .-"a ..=�meLeaO.dfYl-number and SreeC n:Y. are.and
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-REASIIIDlENTIAL ■
Land not exceeding one(1)acre immediately I(1)
surrounding residential improvements
Other land (2)
Total land(line I plus line 2) (3) I
Residential improvements or Dwelling I(4) I
Annually Assessed Mobile I 1
Manufactured Home Garage (5) I
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct,
Sgnavre of Assessor Date signed Inaah day..year)
and complete.
Vmfyig action-Signature of Audtor Date signed(month day.year)
3:= 4 ! ._.Col STANDARD DEDUCTION ALLOWANCE_ t '- -tf,. "t :x`-'7466.- .
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 or manufactured home.
Signature of Anchor Date signed(much,day.year)
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DISTRIBUTION: Ongial-COUmy Nd=or,Fie-Samped Copy-Taxpayer