Homestead_Rybachek (2) r` CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R15/5-14) HC10
Prescribed by the Depahnent of Local Government . •
INSTRUCTIONS:See reverse side for Ong instructions. 9. I
r
NOTE:Telephone,Social Security,drivers fcense,state id-'ILA•n•rid federal identification numbers are confidential under IC 6-1.1-12-37.
^aTATE6IENT -- - - -•' .1 ni 1; •Y
I(We) '/ �Ao certify that I(we)occupied as my(our)prim•-.
place of* - ce or am(are)buying the too rig described real property under contract for which a Homestead Property Tax S(andard
()edit.... hereby claimed on the date pplicedan is signed, (date o/signature). I(Wc(/JN q
❑ •y. ❑ Am(are)buying under recorded contract 2 20/8
❑ 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 peredi ^'n
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. V vN CoU •r j
s
-- _-:;
Recordefa oMoe where contract is recorded 1 Record number Page
e yr v s �l x _-'� r .- _Y. 4 .g:.1c-°-x
:r_.�9,3 .01--�- -. ,�...._-n_A-ci_�:P,ROPFJ2TY:DESCRIP ant _-s .-- _- '�^-� $� _ _
.. /swlr(rst'..town.l w,Si )
0 l�_ a / -1 /��
Panel mcnber Legal desel-Yn lathe prop•ry
0/ ❑Real pope Annually assessed moioe home(IC 61.1-T)Li quesaon
If any portion of the iesi]ueial stnrare or the land not es-e.'f-g one(1)acre that immediately=mounds that anacnae is used to `produce income,descabe the use and portion
of the property utilized to produce income.
6- -la- 101- co- 938-oaa.
Ss•_'•Corny.and Townatup Is claimant vacs' a homestead?
. ' ❑ Yes No
Signsva or roam
I hereby certify the above statements are true,correct,and complete. l�
•Address of rand(number and street Ply,rate,and ZIP coda) L(24 t .std haneasad,y- (murder and Creel,,my.state,and ZIP code)
�
V- , oc! 5 /leo. Sfi o cocci cvi//c X4/
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE ,I NON VESISIDENTIAL
Land not exceeding one(1)acre Immediately
surrounding residential improvements (1)
Other land I(2) Y� 7
Total land(line I plus line 2). (3) - . .. — _
Residential Improvements or Dwelling (4)
Aernually Assessed Mobile! - ----
Manufactured Home Garage (5) r __ .-_- , t 1`1L—
Other improvements (6) •'_:,_`:-_.,:".„ Cal
Total improvements(line 4 through line 6) in
Total value (line 3 plan line 7) I(a)
I hereby certify the above t true,correct, Signature of Assessor Date signed(mptA day,year)
and complete.
Vecyig eaten-Sigranne of Nrd or Date signed(month,day,year)
_ Y -��� r -_' s`STANDARD DEDUCTION'ALLOWANCE� --7a. `
� `5�".-fo _sar-�'
20 pay 20 Lesser of 60%of the aseacsed value of the homestead or$45,000
. Nolxithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
rat exceed one-half(7R)of the assessed value of the mobile home or manufactured home.
Signets•of Hector Data signed(mood day.year)
DISTRIBUTION:Ori'gal-Corey Pudar,FdeSamped Copy-Taxpayer