Homestead_Baehl (2) f CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
cFORMar-N-5. STANDARD/SUPPLEMENTAL DEDUCTION
s:i- State Form 5473(R15l 614) HC10
Prescibed by the Department of Local Co emmem Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Soda/Security,drivel's license,state identification and federal identiSation numbers am confidential under IC 61.1-12-37.
1.'71.w ro • °-7.�. - '15)!GERTIFICATION ST4TEMEYT))_-11 _j.'-1-"';';• -_ g�
I(We) -La' I A t' =' I",c5! $u• a •• � ##2'
III• that I(we)occupied y( r) rinciae !1 tl
place of 7sidence or am(are)buying the followin.`escribed real property under contract for which a Homestead P perty ®g/p/
Deduct).' is hereby claimed on the date this appli.etion is signed, (date of sig r re).
❑ Own. ❑ Ain(are)buying under recorded contract 8 ADD ZJ16
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. APR U
❑ Have a beneficial interest in the trust or the right to ocarpy the property under the terms of a qualified personal residence trust ,
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. I . y al
-
�_•
U buying on contract.Fee Simple owner's name
Recorder's ottce where contact'receded Record number 1 Page
- ,:ti t� ?�a�, _as'lg";r*Wtn PROPERTY,DESCRIRnON` 't:tM�"-a- ,mss
County 1 Township Taxing district(fi):fawn lownrhy)
Pared Weston;
Legal description Is the property liWeston;96- 16-I a - 3o -COQ.-3 gb-oaS ❑Real pmpen) ❑ Annually assessed mobile home(/C 6-1.1-7)
If any porion of the residential cnxarre or the lend not exceedbg one(1)acre that immediately surrounds that stuame is used to produce income,deco-be the use and portion
of the prone y udaed to produce Ernie.
.PROPERTY(WINED ELSEWHEREBYCLAIMAafT ' _ •'!x. It
State,County,and Township Is claimant vacating a homestead?
. 0 Yes 0 N
Si re of claimant T1
I hereby certify the above statements are true,correct,and complete. p p r,,,,r O.8n /)x0,4 //
Address of contact(number and reef,sly.Sate,and ZIP code) Add -vafaIted tteeneeadd,Ganny((nnu'`umber-r and street do state,ere ZIP code)
y30W&SOS For-(8ton(h. lit IJ019
ASSESSOR USE ONLY • _I ASSESSED VALUE ...I HOMESTEAD VALUE It 'NON-RESIDENTIAL- -la
Land not exceeding one(1)acre Immediately > rpT-'-
surrounding residential Improvements (1) __ ->_.a - ._._ _.
• Y — T
Other land (2)
Total land(line 1 plus line 2) (3) - —_
Residential Improvements or Dwelling (4) ;.n•,`-_--,,_- -
Annually AssessedMobilel - - _J ^ ' -
Manufactured Home .-c y -.. "„L-.9
Garage (5)
Otherlmprovement (6)
Total Improvements(line 0 through line 6) IF)
Total value (line 3 pits line 7) I(8)
I hereby certify the above is true,correct, I Signature of Assessor Date signed(month,day,year)
and complete.
Veiling action-Signature of Putter Date signed(month,day,rear)
z2i± :. :== Y', S2.e Meg 17.?iit STANDARD DEDUCTION tALLOWANCE e -&
20 -pay 20 Lesser of 60%of the assessed vtue 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 properly or to u:actured home that is not assessed as real properly may
not err e-haff(1/2)of the assessed be of the mobile home or manufactured home.
Sige-de of e d ' 1 Data signed(. ,dayygarl
K ( � _ Ill%
DISTRIBUTION: Original-CoumyAudtor,FeeSamped Copy-Taxpayer