Homestead_Akers (6) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I
STANDARD/SUPPLEMENTAL DEDUCTION FORM
1 Sala Form 5473(R15/5-14) HC10
�` Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE Telephone,Social Security,drivers license,state identifica.'.n and federal identification numbers are con fide' un.: Iei. 1.1-1.1c7 ',.v
'CERTIFICATION STATEMENT 71",- r.' ' .1.77-".1 -,i _..
I(We)�//1l canto , I certify that I(we)occupied as my(our)principal
place of residence or a re)buying -following described real property under contract for which a Homent off,T Standard
Deduction is hereby d ied on the date this application is signed. _ (data b1134glAtbMe)V ):
❑ Own. ❑ Am(are)buying under recorded contact
❑ 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 Itl y ce trust -
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. llaa l°J ( Q UNTY AUDITOR
- - ,.• : ._ _.-
U drying on contact,Fee Singe owner's name
Reorders oCce where=tact M UCmtded Record number I Page
I
r' .. Y.__ _ sIPROPERTYDESCRP'ON !.=- _£L- ✓ a `.'.77" .'.
County Township rang; .
ic,)
Parcel number Legal de ipton Is the property in question:
N 5 X,c S Pr 4 / ❑Real poverty ❑Annuaey assessed=tie home(IC 6-1.1-i)
h any poi of the msidertl TmCre or the lard not excee g one(1)sae that irmedatsty sxmmds that stnlfLae is rimed to produce income,describe the use and pawn
of the propeny Lazed to produce income.
(o -/a - O 7 _ ?-O/ - 000 . 57S_0 .)-3
PROPERTY OWNED ELSEWHERE BC'CLAIMANT
Sae.County,and Township Is claimant vacating a homestead?
. - ❑ Yes ❑ No
,e of claimant
,�C/I hereby certify the above statements are true,erred,and complete.
Addd ass of wrud(muMnend Street M:stab ZAP....) Address of vacated ,dany(nunsber and greet oily en.sat ZIP code)
" 19/s k . 0 e _ .'i I c' 9 es ( 1 .5 a•
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE -I -NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately 'r"`-"-S`
surrounding residential Improvements (1) °�s5se'.~_r�—.•..-, `.,-?.
Other land (2) _1_ - — _ z
Total land(One 1 plus line I) (3) I —
•Residential improvements or Dwelling (4) I ,,_ _ - .~-F:_ai;+ 3}
Annually Assessed Mobile/
Manufactured Home Garage (b) I -, x4r--471
-
Omer ImProvemenfs (6) L;?..3; ;? '. ,-s -,<<,_x`.
Total Improvements(line 4 through line 6) (7) I
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, I Signature of Assessor Data signed(month,day.year)
and complete.
vadyig action-Signature ofAC:tor Date signed(mth,day,year)
s ""STANDARD DEDUCTION'ALLOWANCE. l-'t - -i
r:t+.'�3+mac-:.. >��^'�a. aR-�-�. s-�.�4s.., �Xi^==�
20 pay 20 Lesser of 60%of the aswssed value of the homestead or 545,000
Notwithstanding 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 properly or to a manufactured home that is not assessed as real property may
not exceed one-hat(12)of the assessed value of the mobile home or manufactured home.
d Doe signed(nosh der.yaM
DISTRIBUTION:Original-Caury Ai=r/ ayayer