Homestead_Memmer (5) .4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-"- STANDARD/SUPPLEMENTAL DEDUCTION FORM
�a � State Flinn 5473(R15/S44) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for fling instructions
NOTE:Telephone,Social Security,diners license,state identification and federal identification numbers are confidential under .1 12-3;
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�� y 'CERTIFICATION STATE67ENT�ti:,°°` _ - 83. f- T 'i'sh 1
I(We) , !J i i a I/irZ�iia� - .I . I �t1:64 I(we)occupied as my(our pnna• .
place of r--(/.ence or am(are)buying the following described real property under contact for which a Homestead Pupy&Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of sgnMS}i I4Ne):2016
.s Own. ❑ Am(are)buying under recorded contract
❑ 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 Qe .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property
lil E7JON COUNTY AUOrrOR
_-_
If toying on inroad,Fee Simple owner's name
Recorder's o.Tiae where comae is recorded Record number Pape -
1.-- -aG :;fir -14 4IWOII--R— 1E5CRIP116174 'r`' .O} � :�"$' .`.ntt_:
Cowry Township 1 Taxing G¢5i vty Sx,)'-.-...
Parse number Legal deaairtian •Z. 46 61,Is the propery in questioo't /
P/-�Ylo /7 . /o G 101 vP Real properly ❑ Annually assessed meta.tame(IC 61.1-7)
If any potion of the residential studee or the hind not eaceecf g one(1)acre that nnedatey astounds that stualse is used to produce"income,describe the use and potion
of the property vaned to produce income.
.140-/2-/ `7 - /o'Y - oa / . 365 -62 7
. _ .-PROPERTY OWNED ELSEWHERE BY.CLAIh1ANT .. _ _ ,
Sate,Carty,and ToarrahM Is claimant vacating a homestead?
. . ❑ Yes ❑ No
re ef da::amt
I hereby certify the above statements are true,correct,and complete.
y
Address of wntad(number end adeot crly fie,and ZlPmde) of vacated ta:.e5ead,d any(number and street dig:stare.and DP code)
- 1 53 :1 d,E --4-t , 4s , 7670
ASSESSOR USE ONLY - , 1 .ASSESSED VALUE I. HOMESTEAD VALUE_ -1 'NON-RESIDENTIAL ' .
VALUE
Land not exceeding one(1)acre Immediately •.c
surrounding residential Improvements (1) __
_ 21-.'iil'..
Other land (2) __._.,.�.-p•_� �_..'.
Total land(line f plus line 2) (3) _ - - -
Residential improvements or Dwelling (4) - - t-
Annually Assessed Mobile l
Manufactured Home Garage (5) •
Other improvements (6) .1:4. 1
Total improvements(line 0 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct, I Signature of Assessor Date signed(uaan.h,day,year)
and complete.
Verifying action-Signature of Aud.tor Date signed(month,day,year)
Ii its
-^ .- ?STANDARO DEDIICTION'ALCOWANCE 3Te- ?:'3- x- }.
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other provhion,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ MAY 4 2016
that is not assessed as real property or toe 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. a;�/s��rca
Signatee of�,A .w Dv/ trvt day, .
� � CID ON COUNTY AuDI IUH
DISTRIBUTION: Origiul-Casey Awfbr,Fie-Samped Copy-Taxpayer