Homestead_Barrett (6) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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_}•- STANDARD/SUPPLEMENTAL DEDUCTION FORM
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State Form 5473(R15/6-14) HC10
Presmbed by the Depa'tnent of Local Government Fin
ent axe
INSTRUCTIONS:See reverse side for flung instructions. .
'NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers am confidential u IC:11.1 ; -37. i )
CERTIFICATION STATEMENT: c•i•- ( I'C:-•• )- r. 1i )r
• I We) S.9.._ • A certify that I(we)occupied as my(our)principal
place of residence•11: I(are)buying the following described real property under contract for which a Homestea e`ppe*/ and
Deduction is hereby claimed on the date this application is signed, (date ofst afore). (V
❑ Own. ❑ Am(are)buying under recorded contract
1 ❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. , • TAMP.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a 4g1lEg'gl(Bf s afar `611-OR
ID Am(are)the shareholder, partner, or member of the entity that owns the property.
:`_.
If IS;on contact Fee nple owmefs name —_— '
Sh
Recatles o5ne where ccntrad b recorded • I Record number I Page
rt€tye p`:niN7"Ix s; 1.- fix _ 3`:rPROPERTY,DESCRIPTIO }° "-lit-- -ir:' -?F . 77.47�z1.0. °-!'i_ °-1
Coley Towns* Tesng dcid(city,fawn.tusns'ay)
Parcel tarter Legal desaiyaon Is the property in quesbrt
❑Real property ❑Amualy assessed amble home(/C 6-1.1-7)
If any*bon of de residential smmae a the land not esnedxg one(1)acre that*sedately s..nnwds that*nee b toed to produce 6gene,describe the use and porn
of the property abed to protium riwoe.
aG - li-1 a - ID-(- 000-0I'I-oaa
•
- PROPERTY OWNED ELSEWHERE BY CLAIMANT _ - , ' -
Sate.County,and Township Is claimant vacating a homestead?
' ❑ Yes ❑ No
signature dasnant /7
I hereby certify the above statements are true,correct,and complete. I�v� ///{1�/'/1 f/j/C
Address of contact(number and greet dg;Cate,and DP code) I of vacated I- rtes?,if any(number end steel. coda)
ASSESSOR USE ONLY I - ASSESSED VALUE_ I HOMESTEAD/VALUE ,I • NON-R/ESISIUENTIAL
Land not exceeding one(1)acre Immediately (1)
surrounding residential Improvements
' Other land (2)
Total land(line 1 plus line A (3) _ - —-- -
Residential Improvements or 'Dwelling (4) I
Annually Assessed Mobile l
' Manufactured Home Garage (5) I
Other improvements I(6) ( s '
Total Improvements(fine 4 through line 6) I(7) I
Total value (fine 3 pits line 7) (6) I
I hereby certify the above Is true,correct, Signature of Assessor Date signed(rnon;q say.year)
and complete.
Verifying action-Signature of Audbr Oats sigred(no*,day.year)
A' u -. __?i(,^STANDARD DEDUCTIONALLOWANCE1-"K 'e'r`-' --_.,w-mss
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
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 property or to a manufactured home that is not assessed as real property may
not ex one-half(12)of the assessed value of the mobile home or manufadured home.
Sgnaa t r Dtg^^dF/j
y
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DISTRIBUTION: Orig6el-County Audlor,FleSamped Copy-Taxpayer