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Homestead_Emge , di - CLAIM FOR HOMESTEAD PROPERTY TAX YEAR STANDARD/SUPPLEMENTAL DEDUCTION State Form 5473(R15/rl 5-14) HC10 Prescribed by the epertnert of Local Goverment Finance Finance FORM INSTRUCTIONS:See reverse side for firing instructions. NOTE Telephone,Social Security;&Vets license,state Identification and federal identification numbers aro confidential under IC 6-1.1-12-37. , _,./�r�� . �/���. CERTIFICATION STATEMENT.:r . .': - i ';^' ��' I(We) _r li e{f.,//I�i ...e...__ - certify that I(we)occupied as my(our)�p jin�dpal � jf place of residence or am(are)buying the following described real iii-rty under contract for which a Homestead Property Tax:at m), / /j Deduction is hereby claimed on the date this application is signed. (date of signature). I(We): ` r tttJll'- ❑ Own. ❑ Am(are)buying under recorded contract Gee le <Os6 ❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. LSD • - 61,,Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal re.ciagsy 1ti, V y❑ Am(are)the shareholder, partner, or member of the entity that owns the property. N TY ' • GV If buying on contact Fee Simple owner's name Recorders o5ce where contrail is recorded Record number 1 Page fi':_€.-. z sn q,..--_ Y� PROPERTY DESCRIPTION 1c"- 4.:rie`,_ - 3--4 s-,..'r ,�vz7 County • rt T a at I i t r • Farrel.,.�.r� I if,- assay-Jai / la tte in quest= / �) - -- 26,- SOO L/ooz 4,Q 7-4)V Real pee erty ❑Annualy assessed roadie home(IC 6-1.1-7) any porton of the Jresider_al -jdae or the land not exceedag one(1)acre that t-uoeda:ely surrounds that stifles is used to produce income.describe the use and portion of Me property vaTaed to podia income. PROPERTY OWNED ELSEWHERE BY CLAIMANT ' - - Stets,Canty.and Twins/lip - Is claimant vacating a homestead? . ' ❑ Yes ❑ No V\SSW if'" "' I hereby certify the above statements are true,correct,and complete. �� • Addess of coma(number and street.rot.date,and ZIP cede) + Address of vacated homestead,d any( umber and sly.date.ed ZIP code) ION IN PAr},;I e Ads. gen.int.r3 rsA/ a7ej ASSESSOR USE ONLY. I . ASSESSED VALUE .I _HOMESTEAD VALUE I NON-RESIDENTIAL •Land not exceeding one(1)acre Immediately .--7TTT _'iC-7 r s.surrounding residential improvements 1) -_•f��+ ---_4t«e. Other land (2) Total land(line 1 plus line 2) (3) _ Residential Improvements or �Negin9 (4) - I _ -+.f . Annually Assessed Mobile o �� _Manufactured Home Q l.-.• - Other improvement e- C1.1 C', a- c_,v,V.l -J ' --�- w Total improvements(line 4 through tin, R. ,t --� 'L \� I Vim' O Qlt rr '1 Total value (line 3 plus line 7) )4 1 ( t, e' `M I hereby tartly the above is true,cor �1 b "CO O L) Das signed(moult day.lean and complete. -a-ell l ' I Vesyeg action-Signature of ALG:or S Rats signed(month,day,yeah Tn—IS ?-,. ' Ft..11.==r'�rIM :< *: %—.1-7Ti NDARDr ar __.- 7 :e 3c-a 1 20 pay 20 I esser of 60%of she 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 toe manufactured home that is not assessed as real property may not exceed one-half(1/2)of the assessed value ot the mobile home or manufactured home. 'Sigreae of suitor Dam signed(nn'C3 day,year) DISTRIBUTION:Origiml-Carey Pastor,FaeSarrped Copy-Taxpayer