Homestead_Folkman CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r' STANDARD I SUPPLEMENTAL DEDUCTION FORM
v Sate Form 5473(81515-14)
Prescribed by the Department of Local 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. ra
•.��.. .. �I- '�ERTTIIFIICCA:IONSTATEMENT- _ '- - - '�r - •'. - `- r. 44%)
I(We Ir/fx<S/,Ir�. r .LfRI!a /Y17O1C) certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Sfanc)grd
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): /A-
❑ Own. ❑ Am(are)buying under recorded contract 0- rp- - if
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. LSD f61
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal resith•-- ••• • / .
CI Am (are)the shareholder, partner, or member of the entity that owns the property. °(� .44
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If b:dog on contact,Fee Simple oriels name
Reou^der's o5oe where comma is retarded I Record number Page
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,CLon t L r ms =-_. -2C.7 .LS -'v7 _ _
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P. .-•r.'—.der Legal description�(�/�/'� /,1yy�r1 Is Me ary in euesbon
n-/////'—/D/ en `-� . r/-✓0 Real Prope ty ❑Amlu➢y assessed mowe tome uC 6:.1 4)
d any portion of the resideraal stud=or the land not eaceedag one(1)acre that im:'edately that dermas is used to produce intone,descnte the use and or
d the property unlizad to produm'vnrse.
PROPERTY OWNED ELSEWHERE BY CLAIMANT -
Sa:e,County.and Township Is claimant vacating a homestead? .
' ❑ Yes ❑ No
Sigpa'.ute of tlaima2
I hereby certify the above statements are true,correct,a�n)d complete. X /j/j�( �2
Address of anal(number and sooef.rdy,state,end ZIP rude) /J a7 j vd(aT.eU .E arty(number end street,ay.state.and�Code)
7 40 A_a/ 14 T .
. ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL SI
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements
Other land (2) �/ . //�� pp -
Totlland(linelplusline2) I(3) � ' .r r • ,- do _ _g'A. ! L
Residential improvements or Dweing (4)
Annually Assessed Mobile i
Manufactured Home Garage (5) I /
Other improvements (6) k'
IL
Total improvements(line 0 through line 6) � O �111ra
Total value (line 3 pits line 7) (6)
I hereby certify the above Ls true,correct, Signature of Assessor Date signed(months stay,year)
and complete.
Ve2yi.-g acion-Signature of Nrttor Date signed(month,day,year)
''° ,ate � ._s`. a=-27 STANDARD DEDUCTIONALLOWANCE-.� - ._i W
20 pay 20 Lesser of 60%of the assessed%Sue of the homestead or$45000
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 property or to a manufactured home that is not assessed as real properly may
not exceed one-half(IR)of the assessed value of the mobile home or manufactured home.
Sigratre of Nadtor Data signed(r:vti day,year)
DISTRIBUTION:Original-County Aud>x,Fie-Samped Copy-Taxpayer