Homestead_Roesch CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
� -: STANDARD/SUPPLEMENTAL DEDUCTION HCRD
Sax Fomr 5473(R151`5-14)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE:Telephone.Social Security,drivel's license,state identification and federal klentificafion numbers are confidential under IC 6-1.1-12-37.
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I(We) F1) a Iffily— �L u_ �4 iiiOCQt.4" certify that I(we) i as i•y(our;i,d• t
place of residence or am(. 'buying the following described real property under contract for which a Horn d fop! T.•{:M • ••
Deduction is hereby claimed on the date this application is signed, (de f slg&t I. . -
❑ Own. ❑ Am(are)buying under recorded contract JUL 1 2016
❑ 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 residence trust .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
4_per
.: .
If toying on contract Fee Simple owrCa name
Rem.-.iees oSce where contract is recorded - Record number Page
"s-Krtizt{-:e-a=s-'s•..- .. .,L _..s.." ROPERTtDESCRIPTION ,;. L'3a.` R`wK;tr-1.—�?3• r
Count' Township I Tatg QaUid(city town township)
•Parcel number Legal description Is the property in quay
❑Real property ❑Annually assessed noble borne(IC 6-1.1-7)
If any portion of the residential sta9ae or the land not exceedng one(1)acre that irn edaely areounds that thructhre a used to produce income,describe the use and porvm
of the property Nd¢ed to preTxe income.
a - —o I- qo0-004 300 -Oa I
sa=t Coauy. T Is claimant vacating a homestead?
J - ❑ Yes ❑ No
p g, I Signature d claimant
t }Ebyfer06,5abov70m is are _V Ile,ii'1 le4
y/y,.�of raaaat(number end stre city,stare,and ZIPodee)) Address of vacated homer-tad if any(number and meet ors sale,and ZIP code)
ASSESSOR USE ONLY 'ASSESSED VALUE I HOMESTEAD VALUE ' ' NON-RESIDENTIAL SI
Land not exceeding one(1)act.Immediately '" r
surroundlnnresidentialImprovements (1) +h"___•�..e_�sr:-s"_a._'
Other land (2) 1......;;,k A.i' -.=.�'.S'
Total land(line 1 plus line 2) (3) - I _ _ _ _
Residential Improvements or Dwelling (4) s�--_ ~^• L
Annually Assessed Mobile l
Manufactured Home Garage (5) _ •„ -. -__
Other improvements (6) r.,, _ �__F __ 1.,‘:.. _
Total Improvements(line 4 through fine 6) (7) I
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct. Signature of Assessor Date signed(month,day,year)
and complete.
Verffying adios-Signature ofAudtar bas signed(north day.year)
��R^"'T - .g. STANDARD DEDUCTION'ALLOWANCE yr' R"
��•.�.�s"•:-.s-�� �• _ - . .r-�°.- .._mss:< 1
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
No:effhstanding 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 manufa home that is not assessed as real properly may
not exceed one-ha 12)of the assessed value of bee home or manufactured home.
Signanae ot7wd:: � - A Date ygred` `i year)
DISTRIBUTION: Orgiel-CartyAUd:.v,FieSamped Copy-Taxpayer