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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