HomeMy WebLinkAboutHomestead_Bye i 4 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
-it�^ Sate Form 5473(R15/5-14) HC10
-"_` Prescribed by the Department of Local Government Foanm
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INSTRUCTIONS:See reverse side for firing instructions. .
VnTE Te••hone,Social Security,driver's license,state identification and federal identification numbers are:. .fide'.al 1•- C
24s8y e(`p` / •_ • _• w, 1. CERTIFICATION STATEMENT':3' '-e•-`oFti. -ar
I fi ( 4- -r certify which a Hared (our)principal
place o l esidence or;m(are)buying the following described r•:Q�m•-rty under contract for which{}lohjet''ead Property Tax Standard
Deduction is hereby aimed on the date this application is sig /-• (date of signature. I ON :
❑ Own. ❑ Am(are)buying under recorded contract
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative using corpoo tign, r,r3�NTY AUDITOR
❑ Have a beneficial interest in the trust or the right to occupy the m under the[ PdM a'i t' personal residence trust
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
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Reorders oCa where anbact is recorded I Record number Page
ila “5.—.*1 7x35sm 7=?%. T .'a. ::::AT,ROPERTY.DESCRIP.T11-5Fe vp2' +�y1- s.Wro_-
County / Township Tama Cott(Ply, ,hxr�_`•'_v
Parcel number Legal description a•s Is the property in quegiar
J� ./ 3�•o' or)/.Was W7 ��/�/%'ieal Proper y ❑Amur% tome(IC SI t-7)
If any port attla resident =hire or land rat ezaedsg one(t)acre that immeckately sm.ouMS that tins.is used to produce income,describe the use and palm
of the popeny raised to produce income.
-. , '.PROPERTY OWNED_ECSEWHERE BY CLAIMANT- _ 4 4 _ 4 - -4.4
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1 Sea County,and Township Is claimant vacating a homestead?
' ❑ Yes ❑ No
I ' of mmard • .
I hereby certify the above s3tements are true,correct,and complete. � 'CA -kAlillt Address of cart/PO(number are greet sly,gate,and ZIP code) , 14 7C ",'" I . haneOeaf, (re v and greet,�tYS[te,and ZIP code)
■ C-( 4$ *j • a .. - /d I a si L v VVV
ASSESSOR USE ONLY l 'ASSESSED"VALUE I HOMESTEAD VALUE i. Ir.: NON-RESIDENTIAL' •
VALUE-'
Land not exceeding one(1)acre Immediately /
surrounding residential Improvements 0) — c1
75 r.=:.._i._,•
Other land (2) • _ . . _, L v-44.
Total land(fine 1 plus line 2) (3) - - _--
Residential improvements or Dwelling (4)
Annually c cared Home Mobile I ._. ,
Manufactured Home Garage (5) ?.-._T? t5'-___'i.
Other Improvements (6) A. T-3;-`._ _
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6) .
I hereby certify the above is true,correct, (Signature of Assessor Date signed(month,day,year)
and complete.
Vortyvg action-Signature ofAW.tar :ti...( ye
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a; ; - STANDARUn EDUCnoNrauOWANCErW">;?# ' 's- it
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000 APR 2 9 2016
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
• that is not assessed as real property or to a manufactured home that is not assessed as real property may
not ex.::•/•ne-hatf(12)of the assessed value of the mobile home or manufarured home.
Signature of 30/ • / 0 - T; 6..•rT. �.
�J�t.,l� Ir R
..,il 1/ I �.�I/1/ . .14 _ : •.SN GO " 49
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DISTRIBUTION: °done]-County AUdeor,File-Stamped Copy-Taxpayer