Homestead_Miskell (2) •
Ar 2'14 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
td te^ STANDARD I SUPPLEMENTAL DEDUCTION FORM
Stale Form 5473(R15/55-14)
Prescribed by the Depanmem of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions r ll
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers are con Manila'yr en 116-11-12-3 i �.J
tea'-7 7,
._ _ 'n/% - !CERTIFICATION STATEMENT T';-ri 1•"."`I r. _ 5 _:..slip" _Tr .? .-r. •,i
I(We) L _I On A/.� / i/(WIJ/Mfl, certify that I(we)occupied as my(our)principal
place of residence or am(are)• .ng the following described real property under contract for which a Homes�pjrty Ta2ard
Deduction is hereby claimed on the date this application is signed, (date na re. 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 gy1lifi r ' tfTOR
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. UU tt33
•
-.
If hying on contact Fee Simple owner's name
Recorders otoe whex contract is recorded Record number 1 Page
.-'.t` = '.St .7'+°'.rdto$°4.7/4 DSRTY,OESCRIPTT�a�10J0-, i=!$S�� Twat T'-n. ':A � tVe
C Township Taxag•/. ,. ry(p ) Tit 10
¢J(T,bson w /§ /� i •Ka_
alaalY/ ,I /5-joo�V /Legal _0a Is Nye pr/operpperty on
C�J[). 7 1L(gi properly ❑ Annually assessed nroWe home(IC 61.1-7)
If any portion of the resideee al esttaa9 or the and not exceeding one(1)acre that inxdate&surrounds that stoats,is used to produce income,desmtbe the use end portion
of the propeny taxed to produce irate.
t PROPERTY OWNED ELSEWHERE BY CLAIMANT _, •_ _ a
Sax,COuray.and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. \i.r `=..:"S
Address d mfas(number and street.ay,Sete,and ZIP code) VT67" 1.ddress off vacated� ead, any(number and green My,state,end ZIP code)
• 3F1 Scrsru V sr f-i_ Oiled
ASSESSOR USE ONLY . r I VALUE 7.trl._'.HOMESTEAD VALUE - I " dON-RESIDENTIAL..
VALUE,
Land not exceeding one(1)acre immediately
I(1)
surrounding residential Improvements
.-1-' - - T G':r
Other land (2)
Total land(line 1 plus line 2) (3) _. I . _ _- .
Residential Improvements or Dwelling (4)
Annually Assessed Mobile! —Manufactured Home Garage (5) - at .ruin']_�
Other improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above Is true,correct, "Signature of Assessor Date signed(mmth.day,year)
and complete.
Vadyirg aeion-Signature ofAUdbr !-
,,_gib-"_ aagyLSg'W i;"• ?STANDARD DEDUCTIONAli OWANCEra
20 pay 20 Lesser 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 JUN 1 216
that is not assessed as real properly or to a manufactured home that is not assessed as real properly may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home. •
�:L4./ • _ . __ i iIi. _s.i� led �T��
DISTRIBUTION:Orgial-Carey Author,Fie-Stamped Cop'-Taxpayer