Homestead_Abell (2) `~CL CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
ef' - 1• STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1515.14) HC10
Prescribed by the Department of Local Goverment Fiance
INSTRUCTIONS:See reverse side for filing instructions
NOTE:Telephone.Social Security,drivels license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
ant'
I(We) . r _ certify that l(we)•;-- p1 as i y(ou ••r ci• '
place of residence or am(are)buying the following described real property under contract for which a Horn_teed i ro5' j-- -•d-;-./
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract AUG 3 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. /
::._,
—.
d buyvq on contact Fee Simple owner's name
Recorder's of.ce where contract is recorded 1 Record number Page
f '_177-S -..• x'.771- r _4A,°='x,;.rcr_PROPERTY,DESCRIPTON iT17_�u'�` w 'j3:. `.-"te`v�s+x,;.•a'�^` yg r
County Township Tavey
i (dry,tam,township)
VXLe
Parcel cumber legal description S S Y t C
Is the prone*in Wester[
{i' 5 taw 19 -d - 9 ❑Real property ❑Annually assured cootie home(IC 61.f-7)
If any potion of the residential z:utiae or the land not exceeding one(1)acre that immediately surrounds that stidure is used to produce intone,describe the use and par
of the;ropey Laced to produce moans.
a6,-1_3 - '? - boa _ 000. 585 - 00V •
" . . PROPERTY OWNED ELSEWHERE BY CLAIMANT .- -
Sys,Caxcy,and Township Is claimant vacating a homestead?
. • ❑ Yes ❑ No
I hereby certify the above statements are true,correct,and complete. I
7r, �
ofcoma(number and street ay,Sate,and ZIP code) g760 q (Address of vacated harer ead,a any(number and saeet,dyt SCe.and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE . I NON VESISIDENTIAL
Land not exceeding one(1)acre Immediately + 7
surrounding residential Improvements (1) i -. __ -- :.c`-
Other land (2)
Total land(line 1 plus line 2) (3) - _. -_ .
Residential Improvements or Dwelling (4)
Annually Assessed Mobile l m -
Manufactured Hoe Garage (5) • • _7'i r1
Other Improvements (6) ,,-, , �
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above Is true,correct
Signature of Assessor Date signed(rnmtA day,year)
and complete.
Vemfyhg action-Signature of Audtor Date signed(moon;day.year)
r- +--` °'ex_ '=K•'- rie sk'STANDARD DEDUCTION'Al1CWANCE -:'--�-`tea-: * tR" ire
20 pay 20 Leg■.•of 60%of the assessed vibe 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 exceed one-half(I/2)of the assessed value of the mobfe home or manufactured home.
$RaabII!d\-e l Date signed(ra+th,day,year)
DISTRIBUTION: Ongial-CourtyAUd:o,Fie-SamµM Copy-Taxpayer L