HomeMy WebLinkAboutHomestead_Tison .. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-•-- FORM
STANDARD I SUPPLEMENTAL DEDUCTION
ti'' State 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 identification and federal identification numbers are confidential under I ._
_ - - _ CERTIFICATONSTATEMENT• -* - - - ' sit (° ) )
I(We) A - 4—. - certify that I(we)o.. . .a. ) _ '
place of residence or am(are)buy'g the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, _ (date ofsgnatrA I Wall qo'c
El L (,G Own. ❑ Am(are)buying under recorded contract. V L U
❑ 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 perso-r, :4,4
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
�. G.I BSON CO
uITOR
If buying on mr5ad,Fee Simple owners name
1 Recorder's ogre where contract c recorded Record number I Page
y ,t..-'<�7'js`.?$` 15'__ .->'i:','t'n rr. PROVERTYiDESCRIPTON.-7Y=3 r-ta`isre-_n ;,ice E
County Township Tasig Q5rid(city,town.townSYy)
n spope Parcel 4 '3`/sE .•3 j . ❑ ry assessed mobile borne(IC61.f-
• If any portion of the residential ce tccae or the land not esreedag one(1)acre that immediately surrounds that structure a used to produce income,describe the use and portion
of the property utilized to produce incoue.
a 647 .0/ - L10 3 - 000 . 74,9 - 0 „LI
• PROPERTY OWNED ELSEWHERE BY CLAIMANT '_
.County,and Township Is claimant vacating a homestead?
❑ Yes 0 N
Signavre of oh
I hereby certify the above statements are true,correct,and complete. �[ rlJ
Address of contact(ma beer and.teal,ray,gate,end ZIP.-.- () Address of vacated iwnestsad,if any(number and greet city,Sae,and ZIP code)
W L / 'mai rL SUG - -4-n..1
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE - I
• NON-RESIDENTIAL
E
VALUE
Land not exceeding one 3am Immediately
surrounding resIdental Improvements I 1I W l +-'_
__ ' -e _.
Other land (2) :.r ..? ;4:-...c��_
Total land(line I plus line 2) (3) I _ __
•Residential improvements or Dwelling (4)
Annually Assessed Mobile l
Manufactured Home Garage (5) —__s. r•?
Other improvements (6) T.2.,...41..---t. ,-n:,__-- _ _
Total improvements(line 4 through line 6) (7)
Total value (line 3 pins line 7) I(8)
I hereby certify the above Is true,correct,
signatue of An----a Data signed(month,day,year)
and complete.
Verifying action-Sgnaa a of Futter Date signed(moth.day,year)
4:71, T?tx`_-e yj ."^'X,i_�•924tteZee'_' STANDARD DEDUCTIONALLOWANCE-a_�-�'*-- '��- -i--''
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Nots dthslanding 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 toe manufactured home that is not assessed as real property may
not exceed one-half(112)of the assessed value of the mobile home or manufactured home.
Sgwarre of Author //'i`�� / Date signed(month,day,year)
DISTRIBUTION:O ,,Fie-Samped Copy-Tayvyer