Homestead_Michel (13) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-<-a- FORM
STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5475(R1515-14) HC70
Presoibed by the Department of later Gown-nerd Faience
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone. ••- Security,drivers kense.state identification and federal id:n5+cation numbers are con5dential under IC 6-1.1-12-37.
• "--•-_r I7 qr.:.-- J;,C • '-/1/f OErRT�IFICATIOV SSTTAATEEMMEENT`. r tom.pr• ,'''+':4" I 5 :Fr 7 !h.
I(We) Ct i 'L fl reari :.L_ t! .e S IC p-• our)principal .
place of residence or am - a b �• •: f
p ) vying the following described real property under con•�• •r - ,y• try Tax Standard
Ded ction is hereby Si •:-•on the date this application is signed, (date of signature). I(We):
11A Own. ❑ Am(are)buying under recorded contract MAY 4 2016
O Arn (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the bust or the right to occupy the property under the terms • . qualifl • pet• - - "dence trust. .
O Am(are)the shareholder, partner, or member of the entity that owns the property. fi t
--
If tubing on contact Fee 56nite owners name
Reader's c5ce where contract s recorded • Record number Page
3l-fA L. 9gCi -m oESCwenor= 1?3i•
Cat). lilt Township Tzvg dsria(oily,town,t n5a') i
4 i li .,
P aanyer Legal description Is the property in Guerin:
Ab-/9.4 ,-3co-Oa). ealbonerty ❑Annually assessed=bee Marne(IC 6-1.1-7)
It any porton of the residential structure or the land not exceedig one(1)acre that'enxdstery amounds that striae is used to produce income,desoibe the use and ponim
of the property valued to produce th one.
•
. PROPERTY OWNED ELSEWHERE BY CLAIMANT - - _ _ ..
,Gassy.and Township (Is claimant vacating a homestead? .
' El Yes ❑ No
I Sipneture of /_ 1
I hereby certify the above statements are true,correct,and complete. '�f/f{5
Address of comsat(number and tree(ay,gate.and ZIP code) Address tatted Mmes ead.if any(number and tee(ay,state.and LP code)
�/VGSE -7505 Rrr {chat pi 4t-7G48
ASSESSOR USE ONLY I ASSESSED,VALUE, I. :HOMESTEAD VALUE I".'. .NON�ESISIDENML•
Land not exceeding one(1)acre immediately (1)surrounding residential residential improvements
Tr.
Other land (2)
Total land(line/plus line 2) (3) _ - ____
Residential Improvements or Dwelling (4) : :;i• �,•n -
Annually Assessed Mobile l
Manufactured Home Garage (5) - _
Other improvements (6) . s. iat
1
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (5)
I hereby certify the above Is true,toilet;
Signature of Assessor Da'� day,Yew)
and complete.
Vedyi g actin-SIgmvre ofAuitar day,yea)
_ .i -+•z rte,"'-+- -STANDARD DEDUCTION'ALLLOWANCE S 1
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or 545,000
Nofwi.Asandug any other-provision.the sum of the deductions provided in IC 61.1-12 to a mobile home
I
that is not- •sled as real property or to a manufactured home that is not assessed as real property may el
not ex••:• • .,haf(IR)ofdie assessed value of the mobile home ormanufacured home. '1147,1r
DISTRIBUTION:Origial-Dourly AScon Fie Samped Copy-T...-$
1