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Homestead_Mallory �., ' CLAIM FOR HOMESTEAD PROPERTY-TAX FORM YEAR -- Q.— STANDARD I SUPPLEMENTAL DEDUCTION Sate Form 5473(R15/5-14) HOW Presmbed by the Deparhorerd of Leal Government Finance INSTRUCTIONS:See reverse side for filing instructions NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6.1.1-12-37. - - 'CERTFICATION STATEMENT,`=� ' _ r »y.. I(We), 'n II . ( let ii / . 1 at - certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following describ-I eal property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): ❑ 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 personal residence trust . ❑ Am(are)the shareholder, partner, or member of the entity that owns the property. =;! C buying m contact.Fee simple owner's name Recorders°Mce where contract is recorded - Record number Page 64749'3. .': S A`'_77-4t.='Z?i.A'is:e4"rit PROP,ERTVtDESCRIPTION�4-nn + 4'713`•t'- TOrS10' mein-�r-g'j County Township Tang district(city,toss,townshp) rte ao -oa-tecl` =�co©, 2f9Lr3,meao . „e weskit cal pcteienY ❑Anent/acoe,w mobie lame(re 61.1-7) If any portion of the residerael era or the land not eeceedrg one(1)ace that iranedatey surrounds that .irrwre is used to produce income.de cRhe the use and porous of the property udtzed to produce Somme. • ._ _ _ .:_PROPERTY OWNED'ELSEWHERE BY.CIY,IMANT, - J::',.:17‘-:::_"7-2.:2-:- -,W✓` ;''7 ?t •_ ., 1,1.}?`: Sate,Comes and Township Is claimant vacating a homestead? . ❑ Yes ❑ No Signature of dal-tart I hereby certify the above statements are true,correct,and complete. X �7 //J Address of contact(number and Sree:Sly gate,and ZIP code) I A!esa 6f vacated. homestea,( a any(number and oiy state,and ZIP code) A Le:U. . Te, ems. • wr 'ASSESSOR USE ONLY I � •ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL �.-VALUE • Land not exceeding one(1)acre immediately surrounding residential Improvements (1) Other land (2) YVT V.aollanv ,uNnoDNOSSIE Total land(line 1 plus line 2) (7) fit I! ri -_-- -- Residential improvements or Dwelling (4) t-vi-^LT` ~D �' Annually Assessed Mobile/ --- �.-_=.-"'r 1va�" - Manufactured Home Garage n - �p� ,7T Other Improvements (6) U.__ri,' �' tat rc Total Improvements(line 4 through line 6) (7) ' p1 ' 1 Total value (line 3 plus line 7) (5) 1 I hereby certi certify the above Is true,correct Signature of Assessor Date signed(month,day,year) and complete. veifyig action-Signature of Auditor Date signed(month,day.year) 41- S ms` arT =- TS STANDARD DEDUCH ALLOWANCs- ? -5--'-,`-':-.(ric.',�`5 20 pay 20 Lece.r of 60%of the assessed value of the homestead or$45,000 Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S that is not assessed as real properly or to a manufactured home that is not assessed as real property may not ex one-half(Ii?)of the esse value of the mobile home or manufactured home. Son Do sivrpl(nosh.day,year) C �� s 6=1 8-I DISTRIBUTION: Original-County Auditor.Fie-Stamped Copy-Taxpayer