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., _ CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
N.... STANDARD I SUPPLEMENTAL DEDUCTION
- ` ? State Fans 5473(R15/5-14) HC70
Prescribed by the Department of Loral Gover..:xd Finance
INSTRUCTIONS:See reverse side for Sling instructions
NOTE:Telephone,Sod:f=.nix drivels&tense,state identification and federal identification numbers are confidential under IC 6-1.1-1 ,: .
- _ '-_ - - 17 , - ; %' ,<-2,-;-t-CERTIFICATION STATEMENT I: emu- -•-c e er" s -S 7r:' r /
I(We) certify that I(we)occupied as my(our)prindpa
r Ii
place of residence or am(are)buying the foil oxing described real property under contract for which a Homestead Property -�C)' rd
Deduction is hereby daimed on the date this application is signed,
U buying on coraad,Fee Simple owner's name
Recorder's ohm where contract is recorded • Record number Page
-4#.. Y ' Lt_ra..,'_'" a ti.t„• ¢PROPERTY,DES Cal P-TION-Mit.M '--�-e"-- :C 9
/ fa(city,low'nlawah'p)
Parcel number r M avi //o/v 2/ W pe q N p ep+rs
t
❑Armco%assessed mobile home(IC 6-1.1-i)
11 any of the resider l rcre O land n exceed one(1)acre that immediately
stance is used to produre'vaorce,descma the use and portion
a •G+operty mitred to produce ire me.
0673- /9 goo? .o91. aso -oar
, r . . - "- - - -
_ PROPERTY(MINED ELSEWHERE BY CLAIMANT.�_�_ � -'f � '
Slate,County,and Township Is claimant vacadng a homestead?
. ❑ Yes ❑ No
Signature i�
I hereby certify the above statements are true,correct,and complete.
Address of coreaci(number end saee(at,, ate,and ZIP code) Address of vacated txnestead,L any(number and s'eet,city,state,end ZIP code)
x (0. 3- zsf i?egne,sce, x1A) f?eV
ASSESSOR USE ONLY - . t - ASSESSED VALUE I HOMESTEAD VALUE •wI. O-NON yESIUENNAL
Land not exceeding one( l acre Immediately
I(1)
surrounding residential Improvement
Other land (2)
Total land(line 1 plus line 2) (a) I _ ——
Residential improvement or Dwelling (4) 14' "_
Manuf Home I I
Manufactured Homo Gage (5) y a:LLiy s —
Other Improvements 1(6)
Total improvements(line 4 through tine 5) Iv)
Total value (line 3 plus line 7) 1(8)
I hereby certify the above Is true,correct, I Signature of Assessor Date signed(math,day,year)
and complete.
Venfyirg action-Signature ofAUd:tor Date signed(mend{day.yeah
v STANDARD DEDUCTION ALL'OWANGEc` v -..; . .s=- 'ogee`-�>s,
20 pay 20 Lester of 60%of the assessed vale of the homestead or$45,000
Notwithaanding 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-halt(12)of the assessed value of the mobile home or manufactured home.
Sgntse of Audio, Date signed(month,day.year)
DISTRIau1TON:Orgthal-County AUdtor,Fie-Stamped Coq-Taxpayer