Homestead_Hayes (3) _ ..e. _ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
- STANDARD I SUPPLEMENTAL DEDUCTION FORM
ci"�r
State Form 5173(Kati/Ste) HC1O
Prescribed by the Department of Local Govertuned Finance --
INSTRUCTIONS:See reverse side Tor filing insfmcfiw,s.
NOTE:Telephone,Social Security,drivel's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
- ,,7/, - CERTIFICATIONSTATEMENT':r _ ' ] �
I(We) -��/�f/����?/(/1/���L�i/ certify that I(we)occupied as my(o: n •-I 1.�
place of residence or am(are)buyin•/e following described if property under contract for which a Homestead Property -- -•t- .:
Deduction is hereby claimed on the•.te this application is signed, (date of signature). I(We):
2gOwn. ❑ Am(are)buying under recorded contract MAR Mn(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 1 r 2016
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal reside.-- trust .
17 Am(are)the shareholder, partner, or member of the entity that owns the property. •
-
If buying on contact Fee Simple owner's name
Recordefs o`ice where contract Is recorded • Record number 1 Page
nr—r-. 7.7=aaiE..` P.ROPERTY,DESCRIRTION°,till A' = ——.' �8`° `s.
Cam . . ' ''�i s., . J 1 // /. /id
-1-Frnu.bar •esoid is the property in quesbm
acct property ❑ Pmwiy assessed rmbie home(/c 61.1-71
d- ..y don of the resider al=tan or the land not e •one/(1�))aace��euaI ironed ely sutra] that s'.rucEUe is used to podum income,deacite the use and portion
of th lip cry crazed to pod=income. /' /0sa�;s/
�£-/9-Lf/,jai-cW VW/o— WY
sa..,Casey.and Township Is claimant vacating a homestead?
. . ❑ Yes ❑ No
— of dal.
gna
I
arl
hereby certify the above statements are true,correct,and complete.
Address of rarcad(ranter and Sheet oily,Kate,and ZIP code) 47('39 Addess of vacated fn.-esaad.if any(number and street ray,ewe.and ZIP code)
/A 30-7 EST -7/8500 /-/AU AOt W N
ASSESSOR USE ONLY • • •I • ASSESSED VALUE I HOMESTEAD VALUE I NON VALDEMWL
Land not exceeding one 0)acre Immediately 11)
surrounding residential improvements
Other land (2)
Total land(line I plus line 2) (3) .. . .
Residential Improvements or Dwelling (4) 'x
Annually Assessed Mobilel
Manufactured Home Garage I(5)
Other Improvements (6) '`�.'!Ya�� ;F- i
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) I(6)
I hereby certify the above Is true,correct, I Signature of Assessor Date signed(north,day,year)
and complete.
Voting action-Signature oAUdter Date signed(month,day,year)
rssa• '•r.friiMSt�" STANDARD DEDUCTIONAL'LOWANCE .:_i�'./ 2 "=`
20 pay 20 Lesser of 60%of the accessed 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 $
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.
Slgrfle of Auditor Date signed(mach,day,yea)
DISTRIBUTION: Original-Cony Aidror,Fie-Samped Cop/-Taxpayer