Homestead_Dove (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
v'., STANDARD I SUPPLEMENTAL DEDUCTION
- Stab Fonn 5473(R1515-14) HC10
Prescribed by the Depa.'.mett of local Gwertvnerd Finn race
INSTRUC770NS:See reverse side for fifing instructions I - i !
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NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential un :r C•I..1-i--37. x
.-'i - i9 '.CERTIFlCATION STA_.iEMENF - ter,1„+_c _ - i
I(We) I I _li In I I I_ - MOW certify that I(we)occupiqdras!l1my(our)principal
place of residence or am(are)buying the following described real property under contract for which a HomesteaAWSer4•bx DMard
Deduction is hereby claimed on the date this application is signed, - (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract aem
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ((� L�tccr����'� �� �r�a�ct�
o Have a beneficial interest in the trust or the right to occupy the property under the terms of a gaAnneo.fsrsar®I T"T'HtrufTOR
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
It hnM g on contact Fee Simple owner's name
Recorder's oZce where=tact is recorded • Read number Page
Tca7 = ` 'T�'r a 2 PROPERTY,DESCRIPTION MtT?3 g j 4 h'T�.'r
own'• • -L
0
Prcel amber Legal desaipaf
a,-/o 'CY-got—Q:3- I Ne pedy s• -
. /0 V V• a ropecy ❑/.'+uay assessed mole home(IC 6-1.f-i)
If any potion of the residental stnbae or the land not exceeds";one(1)acre that immeda:ey sunouo that strWUne is used to produce income,describe the use end portion
of the property Lunged to produce borne.
. PROPERTYOWNEDELSEWHEREBYCCAIhWNT .
State,Comfy,and Township •Is claimant vacating a homestead?
. . ❑ Yes ❑ No
signs'
I hereby certify the above statements are true,correct,and complete.
Address of contact(number end(street my,Sate,and ZIP COCe)21.5w J ytl•f.. dress of vacated homestead,if any(number and greet Cty,Sate,and ZIP code)
$41,0211-.5, .5•J"JR•w+o$4".C71-• r-7$--
61.
" ASSESSOR USE ONLY I - _ASSESSED VALUE ' I ••HOMESTEAD VALUE I:_ ';NONRESIDENTIAL
Land not exceeding one(1)acre Immediately I(11
surrounding residential improvement -Other land (2) •..__-_ ._..-_... • s.
Total land(One(plus line 2) (3) _ - _
Residential improvement or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) :'A j..-.Y.&._
Other improvement (6)
Total Improvement(line 4 through line 6) (7)
Total value (line 3 pits line 7) (6)
I hereby certify the above Is true,correct, Signature of Assessor Dam signed(month,day,year)
and complete.
Vatyig action-sigma-re ctA,Lb Date signed(mant4 day,year) .
' - -•;r 'T'L'.-??sL Y STANDARD DEDUCTION'AbrOWANCES '1/4•
20 pay 20 Leexnr of 60%of the assessed value of Me 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 esse as real property or toe manufactured home that is not assessed as real property may
not ex on half(112)al the assessed aloe of the mo[bffee ho e or manufactured home.
sgm]l J` W Ox i9� yaa7
DISTRISUDON:Original-Courey A dot,9.-Stamped Copy-Taxpayer