Homestead_West _r, _ CLAIM FOR HOMESTEAD PROPERTY TAX ( YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sate Form 5473(R15I5-14) HCto
Presvihed by the°epacment of Local Govvrrent Finance
INSTRUCTIONS:See reverse side for fifng instructions. -
NOTE:Telephone,Soda/Security,drivers license,state identification and federal identification numbers are wnfidendal under IC 6-1.1-12-37.
I(We) 'Gin L _•L• • I" • certify that; -)•(-.• led asyur 1D•-1
place of residence or am(a� buying the foti• g described real property under contract for wt1i.-': Ho =.t-=• .. iard '
Deduction is hereby claim:•on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract S E P 14 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 qualif=d personal resid-nce trust .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. ail
_.__. _• _ :- ^ ,.,
:.
It burg on contact,Fee Simple owner's name
Recorders office where content b recorded Record number Page
T -i _Tier: ;'iVXr .i_ ' s:_a .i.L'TPROPERTY.DESCRIPTO HEa _M ;7".' 2` A
_ County TcwnsO Taxing Sei%tontownship) /
Parcel number Legal desaKo
inn /-U r'4 1-- Is the property q
y in ues co,
Pr Seed /e! '}, f-/o ❑Real property ❑ ,asr y assessed mobile home VC 6-1.1-7)
It any porton of the residential=inure or the land not exceedag we(1)acre that inu:edattely=rounds that ennsse is used to produce income.describe the tee and police
of the property tfciced to produce femme.
2 (, o5 - 3g- oo /_ o03. o9i , o/ '
•..a . - . _ PROPERTY OWNED ELSEWHERE BY CLAIMANT - _ _
State,Carty.and Township Is claimant vaabng a homestead?
❑ Yes ❑ No
a claimant I�I hereby certify the above stements are true,correct,and complete.S �1��`V I,.dd�dn.�tl(mi nter and sbee4 sty,state,erd ZIPcede) r8sd eni(number ends3eet city:laze,and ZIPcode)I
94' I . Y Pa��i by 47666
ASSESSOR USE ONLY' ASSESSED VALUE .'I HOMESTEAD VALUE' NON�ESISIDENTIAL
Land not exceeding one(1)acre Immediately
surrounding residential Improvements I(1)
Other land (2)
Total land(line 1 plus fine 2) (3) - . _ . _ _ _ I
Residential improvements or Dwelling (4)
Annually Assessed Mobile I _ -- - . v.
Manufactured Home Garage I(5) — i
tu
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) IN
I hereby certify the above is true,correct. Signature of A••«•m Dam signs(month.day,yeah
and complete.
ve tg anion-Signature ofArad:a Date signed(month.day.year)
elek"�_s,..4r ---�.-- c' .=-. -y`YSTANDARODEDUCTION ALLOWANCE'-W5i i:s*.�.E:,,
20 pay 20 Loc.-Pr 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 Net is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Sign�rr of ' / Dan signed(rm¢'r,day.Year)
DISTRIBUTION: Orignal-CatryAnd:oh Fie-Stamped Copy-Taxpayer