Homestead_Westlund (2) Ay sc - CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
+ STANDARD/SUPPLEMENTAL DEDUCTION
Site Form 5473(R15/614) 1101
Prescribed by the Depar• ent of Local Government Finance
INSTRUCTIONS:See reverse side for fling instruction°
NOTE:Telephone,Social Security,driver's license,state identification and federal Wenn:ation numbers are confide 1., • •e C rk•.1-12 'r
7. c -- v - CERTIFICATION STATEMENT'-t -_•.'_-. "{fir '" v- F-; 1J1-r --- •
t
I(We) Si Lt.— certify that I( t occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homeste,,*F�{{oqQrCt,'�lT�".'and
Deduction is hereby Claimed on the date this application is signed, (date ota atuM).UI
❑ Own. ❑ Am(are)buying under recorded contract e1
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. r,}ii7pE
❑ Have a beneficial interest in the mist or the right to occupy the property under the terms of a qualified •_-Ih) -1- •- )T.R
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. G(BSON C S •
�__
If buying on centracf.Fee Simple owner's name
Remodel's oat where rarmad is recorded • Remd number Page
r. ..- �-C-_7' f `_ X3.7 PROPERTY;DESCRIPTION- im,._-.i s f°` _eSrif a 4"..-a
County Township (�A'- rownshj,)
property Panel(amber Legal description Is the prroperty in ques]orc
Dst�seal property ❑Amuaiy assessed male home(IC 6-1.1-7)
If any portion of the residential strsCVe or the land not exceedng one(1)acre that Irmmeda:ely surrounds/ _Nat strumse is used to produce home,descibe the use and portion
of the property iedded to produce frame.
C2 &,—i 2-07-'lig1 603, 130 oa 8'
L. • _ - PROPERTYOWNED ELSEWHERE BY CLAIMANT . -
State.County,and Township Is Claimant vara5ng a homestead?
. . • Yes ❑ No
I hereby certify the above statements are true,correct,and complete. ,' � ie
Address of potted(mortar and street-^,state and ZIP code) Address of vacated homestead.L any(number and sued,ply,state.: ''.F node)
I SI • friars /
•
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE' NON-RESIDENTIAL
VALUE .
ILand not exceeding one(1)acre Immediately
surrounding residential improvements I(1)
.Other land I(2) ir:.,.:."`i=-...
Total land(line 1 plus line 2) (3) - _ I - , — --- -
Residential Improvements or Dwelling (4) ?
Annually Assessed Mobile I
Manufactured Home Garage I(5)
Other improvements 1(6) tx i }
Total improvements(line 4 through line 6) I(7)
Total value (line 3 pica line 7) I(a)
I hereby certify the above Is true,correct, I Signature of Assessor Date signed(ramp day,yam)
and complete.
Veleytg adun-sgraame cf Aruthor Date signed(month,day.year)
'° '_r.--rxa'fr r--?�,t: STANDARD DEDUCTION'ALL'OWANCE? = tnL�/- e`I
20 j[Q pay 20 17 I esser of 60%of the assessed value of the homestead or 545,000 '
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
SgnatureC4uup000ymss , /�/ t OP Ora signed(mom*day.year)
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L _1 10.4�4. --✓YL-4SAC
DisTRIBUTION: Origial-County AUddor,FleSamped Copy-Taxpayer