HomeMy WebLinkAboutHomestead_Scott (4) r..- _ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
I� '° ° STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R15/5-14) HMO
Prescribed by the Deamnem of Local Govemact Finance
INSTRUCTIONS:See reverse side for firing instructions
NOTE:Telephone,Social Security,drivel's license,stale identification mid federal identification numbers am confidential under IC 6-1.1-12-37.
I(We) I certify that I(we)occupied as my(our)principal
place of residence or am(a buying the following described real 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. ❑ Mn(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.
;$:. ;
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d buy'og to cosine,Fee Simple ownefs name
Recorders Dyne where toted is recorded Record number Page
d'..
. Casty TownstiP l Taxing - ,town,tonns'z)
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Parcel member Legal description /y�..� Is the in question:/Eaq„A o 9 7 / Real Property ❑Annually assessed moble home(IC 6-1.1-7)
it any portion of the residetal shx:m a the land not exceedng one(1)acre that irtuneda:ety surrounds that sTCNre is used to Produce income.describe the use and panto
of the popery termed to produce iit e.
a62 - /a - 7 - ao3 - 00-3 . toe . oxe
• E
.. , ' _ ELSEWHERE BY C• PROPERTY OWNED CLAIMANT w s•
Sale.Courtly,and Township Is claimant vacating a homestead?
` ' (� ❑ Yes ❑ No
Sic, I hereby certify the above statements are true,correct,and complete.�L ( -•\ y
Andress of Ott(teeter are greet,cry,5re,end ZIP rode) ' \I Address of vacated homestead(,S any(number and ebeet dy,Sale.end ZIP tole)
ASSESSOR USE ONLY - I ASSESSED VALUE I 'HOMESTEAD VALUE.r I. NON VALUE�AL .
Land not exceeding one(1)acre immediately 11) 1.;:-.s.2.1,1.,...._111.,-.;:1•1- r --
surrounding residential improvement _
'.are.'"-:�—..t,•_ '
Other land (2)
Total land(line 1 plus line 2) (3) _ I _ _ _
•Residential Improvement or Dwelling (4) ,�Y1 . :
Annually Assessed Mobile I - - -: --- L.5... .,.�'1
Manufactured Home Garage (5) K s v 3i
Oder improvements (6)
Total Improvement(line 4 through line 6) (7)
Total value (line 3 p/rs line 7) I(8)
I hereby certify the above Is true,correct, I Sgnabm of Asses. Date signed(moth,day,year)
and complete.
Vet-tying action-Signature ofAt dtor
'i
Fr e_ - — , `STANDARDDEDUOM)N ALLOWANCE W".—':"?;'_:.r. -y ter°' -Wa
20 pay 20
ths'andirg any other provision,rthe sum of the deductions rovided in IC6-f l-l2 to a mobile home 5
JUN 9 2016
that is not assessed as real properly or to a 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.
Sig:- N'/F� L D s�
Q e GIBSD COUNTY_
oISTRIsUnON:Orghal-Courtly Audda,Fle-Samped Copy-Taxpayer