Homestead_Wolfe (2) 4..,_ y CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
rt STANDARD/SUPPLEMENTAL DEDUCTION FORM
Stab Form 5473(R15/5-14) HC10
Prescribed by the Dena-talent of Local Government Finance
INSTRUCTIONS:See reverse side for fling instructions
NOTE:Telephone,Social Security,drivels license,state identification and federal identification numbers am confidential under IC 6-1.1-12-37.
I(We) a certify that I e) pi- a co o j) no 1
place of residence or am(are)buying the foil g described real property under contract for which a Homestead Proper lax S n and
Deduction is hereby claimed on the date this application is signed, (date o/ mature). I(We):
❑ Own. ID Am(are)buying under recorded contract S E r 8 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 properly under the terms of a qualifi rsonal I .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
.
If by4g on meeact,Fee Simple owxts name
Recorders o5ce whose dxtad is recorded • Record number I Page
f'.e.4.T t _ .. -�4 - T. ,y?_-t- :.iPROPERTTDESCRIPNON . s:2-- -gaTtXVS.t ras-sW-7,rtaS
Catty
1 Towlstp I Taag d(dry fosw loentup)
Patel number Legal d` Is the drafted).in question'
oe� gear(/ /1/
❑Real property ❑Annually assessed mobile home(1C 6-1•1-7)
If any paten of the residerdal sT.lchae a the and not exceeding ale(1)acre that immediately surrounds that 5nl9ae is used to produce income,describe the use and portico
of the properly Waltzed to produce income.
240 —/ X '47- 3o? —coo . 9 atf 0028
PROPERTY OWNED ELSEWHERE BY CLAIMANT -
Sab,Carty,and Township Is claimant vacating a homestead?
' ❑ Yes ❑ No
I hereby certify the above statements are true,correct,and complete.
r
Address of contact(number and sued,ay,gab,end ZIP code) reneatead.E airy(number and sheet dN.gee,and ZIP code)
/29 (/ ti. 5 ;40cv lie/Aara<//W
Land not exceeding one(1)acre Immediately - R ---,
surrounding residential improvements (1)
Other land (2) _.� ....
Total land(fine 1 plus line 2) (3) _ _
-- - "T- rr"4.77 S-:
Residential Improvements or Dwelling (4) (•- - �Z,..2
Annually Assessed Mobile) -
Manufactured Home Garage (5) I F av r' a
Gana V'-'_.h=.,:.i-urs:=5_:
Other Improvements (6)
Total improvements(line 4 through line 6) (7)
. Total value (fine 3 plus line 7) I(6)
I hereby certify the above is true,correct,
Signature ofASUSSOr cab signed(rm11t day,yeah
and complete.
tying adorn-S sae ctNGa Date signed(mora day,year)
rt. trt 111.7 6e1STANDARD DEDUCTIONALLLOOWANCE .`Y "',' t'' We r,„;)•
20 pay 20 Laswr of 60%of the assessed value of the homestead of$45,000
Notwithstanding any other provision,the sum of the deductions provided in lC 6-1.1-12 to a mobile home $
that is not assessed as real property or foe manufactured home that is not assessed as real property may
not exceed one-hall(12)of the assessed value of the mobile home or manufactured home.
S'tta]r;ofAud or Dab signed(mono day,year)
♦ {I
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DISTRIBUTION:Origsul-Cana As t,file-Ramped Copy•Taxpayer