Homestead_Loveless (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
Ai" STANDARD I SUPPLEMENTAL DEDUCTION FORM
i 4. Sate Form 5413(R15/514) HC10
Prescribed by the Depa'.ment of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers am confidential under IC 6-1.1-1237 !
`- - •• '. :� - •. ._• .CERTIFICATION STATEAIENT`.Y�� _ - �` --' - . :_ -'- _,i f�•' �1
I(We) ..://.n/1aniII/laree�/.� �i = 1 certify that I(we)occupied as my(our)prim.. '
place of residence or am(are)b 1 the following described real•roperty under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on ts-date this applintion is signed, (date of signature). I(We)AIAR (f c�
go Own. ❑ Am(are)buying under recorded contract , 9 CU1G
❑ 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 qualified persord side • ,i,;•.. !
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. seaside I�Ii
co,,Ux t
If buying on contact.Fee Simple mwnens name
Recorder's oSm where hatred Is recorded - Record number 1 Page
nQ - •iiSii �.er¢:aiPROPERTYDESCRIP,TION;, ,C `t-` di _'-
Coury Township Tau'gb}7id(ci:1:I�
Parcel number Legal description CC�� Ishhttree n
property in questio
>a
Real property ❑Annually assessed noble home(IC 6-1.1-7)
If any paten of the resdervl aTnn or the land not exceeds);me(1)acre that immediately surrounds that strixtre is ned to produce inane,describe the me and pores
of to property Laced to produce bmoa:e.
jp_Iy_o7- -Ciao one /. 00Q - oo
- . PROPERTY OWNED ELSEWHERE BY CLAIMANT • - -- -,
Bas.Canty,art Township Is claimant vacating a homestead?
❑ Yes 0 N
I hereby certify the above statements are true,correct and complete. //
�fi ZOUC--/f.SS
Address of contact(number and sheet.coy,slate,and ZIP Code) Address of vacated homestead.S any(number and.&heat,raft Sat,and ZIP code)
a4V s i. 00 E OCa. .a•
ASSESSOR USE ONLY I ASSESSED VALUE I- HOMESTEAD VALUE , I ' NON SISIDENTIAL
Land not exceeding one(1)acre Immediately -"7- _�- ^-d`p
surrounding residential Improvements I(1) s 3 e .._,.,_._.-
Other land (2) s•
Total land(line 1 plus line 2) (3) - _ _. .
•
Residential improvements or Dwelling (a) — :ti_i•m `
Annually Assessed Mobile l c
Manufactured Home Garage (5) _ t`! _ _ _1'- - 2.2;
r'
_ rz •
Other Improvements (6) • --R _s._
Total improvements(line 4 through Tine 6) (7)
Total value (line 3 pits line 7) 1(8)
Ind coy certify the above Is throe,correct,
Signature of P••-••or Date signed(meth,day,year)
and complete.
V..:yoy adieu-Sigraare ofPodtor Date signed(month,day,year)
— y, :STANDARD DEDUGTION'ALCOWANCE .- - ,gfr.-- `-j
20 pay 20 Lfccnr 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 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(12)of the assessed value of the mobile home or manufactured home.
Das signed(north day.yeas)
DISTRIBUTION: Original-Carry Auddor,Fie-Samped Copy-Taxpayer