Homestead_Retana (2) ire CLAIM FOR HOMESTEAD PROPERTY TAX _
STANDARD/SUPPLEMENTAL DEDUCTION FORM
s z State Form 5473(R15/5-14) HC10
Presaged by the oecaranem of Local Government Fiance
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.
._.+— :: -__ _. -- •-._ OERTIFlCATICV STATEA5ENT — '. ` �' _ -.
x
I(We) H�• E_ !-- __• .._• certify that I(we)occu -- as 1 l ur)pn i....1 ,`1
place of resi•-nce or am(are)buying the following•scribed real property under contract for wtsidt a Homest-!. Prot r. ,- •
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ ATn(are)buying under recorded contract JUN 27 201,
❑ 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 rsidence trust
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. e4
,I•r..SAY/ .a
« _.�+
If buhig contact.on conct.Fee Simple ownefs name -
Recordees oSce where contract is recorded Record number 1 Page
y,M'`.- `g lIT.: .a:-•ti_'C�zt +r'Tr- `�‘LPRORERTY,DESCRIP,TIONr—Fi ice_ 87.-- ; ' SI
(Cant' Township Meng (city,town,township) c
Parcel number Legal desaipdon Is the property in guts:inn:
r. T L / _ Zr.. ,Q i Q 5 ❑Real property ❑ Annually assessed noble home(IC 6-1.1-7)
d am por of the residacal s]ae or t..land not exceedrg apex))ace that nv edia:sly_Jsurrounds that Sructre is used to produce income,descibe the use and pu
of me properly c^daed to produce borne.
01% fa- 14-18 - /or'- OOf. sY `I - o07
. PROPERTY OWNED ELSEWHERE BY CLAIMANT - _, .
Sat.Casty.and Township Is claimant vacating a homestead?
' .0 Yes E) No '
I hereby certify Me above statements are true,correct,and complete.
..._.of mean(number
�-arcd�5rae(city,date,end ZIP code) �I • '1 } Address of vacated twnedead.rt any(number and•�rdy,dot,end ZIP code)
No 1Z5 e F .1 1.._. I . f /J/7
ASSESSOR USE ONLY _ ASSESSED VALUE • I HOMESTEAD VALUE tI - NON-RESIDENTIAL
VALUE-
Land not exceeding one(1)acre Immediately a_
surrounding residential improvements (1) 7,5r:_x.:-._.:?+i. 1.74_.2
Other land (2)
Total land(line 1 plus line 2) (3) — _ -
Residential improvements or Dwelling (4) •t..":)•- '},"" ,
Annually Assessed Mobile!
Manufactured Home Gans 7,b ° - `
Other improvements (6) - -_ .`
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) I(8)
I hereby certify the above is true,correct, Signature ofP Assessor Dot signed(=WA day yew)
and complete.
Voting action-Signature otnudtor Date signed(month,day,yeas)
is-- �•'+'^ �" sr'-3a "STANDARD DEDUCTIONALLLOWANCE —°• �,s `
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any o:herproviNon,the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
that is not assessed as real property 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.
Signature of Audtor Date signed(mirth,day.year)
ma c: A 4r-
DIs TRI BtrnoN:Origial-County AUd:.or,Fie-Stamped Copy-Taxpayer