HomeMy WebLinkAboutHomestead_Peach (2) r.e -- CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5473(R15/5-14)
HCIO
Prescribed by the Department of Loral Gove,.a....nt Finance
INSTRUCTIONS:See reverse side for fi&w7 instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identificafion numbers am confidential under IC 6-1.1-12-37.
.
(dell / nature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract L I 1 4 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 quali; /person res' ee-tr0 t .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contract,Fee Simple oerern name
Reczdees c.se where=tact 6 recorded • Record number Page
-..s. {iF2`ar " '=:' C T,-t '-,_,--=..alirROPERTY,DESCRIPRON; t_ .r'? yt'�;:=a1.11riti ."'T i r
(more'-Y
Township Taa'6rid(dtY )
Parcel camber Legal desaipaco LC) AL Is the property in Cuestna's
'T Sw N W a a -3 - Q ❑Real popery ❑ Annually assessed cootie tome(ic 61.1-7)
It any portion of hie residercal s:jdzn or the land not exceedig pre(1)acre that emmeda:elyy surrounds that stturbue a used to produce income,descibe the use and portion
of tie po ecty Pitied to p"aduce erre.
a6 - ao - } d - too - 00i 75o - oo /
PROPERTY OWNED ELSEWHERE BY CLAIMANT -- • _ .('_ ..
Sas.Casty.and Towreiip /J Is claimant vacating a homestead?
��myyyaaa / ❑ Yes ❑ No
I hereby certify the above statements are true,correct,and complete. // /I /,/J
(�dtessof contact(number and.street,cityNate,end ZIP cede) Al fva'�csted ho/�Q//eiva any(number end street oty slate.end ZIP cede)
? 7 S 60 E Ia/E/ 1if 766•
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL :
Land not exceeding one(1)acre Immediately- "r
surrounding residential Improvements (1)
..9.ar
Other land (2) _��:"'_.A:..',.._+�..i
Total land(line 1 plus line 2) (3) _ _(
Residential improvements or Dwelling (4) s i „ *.At, -cd
Annually Assessed Mobile)
Manufactured Home Garage (5) • t -
,.-:f
Other improvements (6) _ _ _.k..'-��_
Total improvements(fine 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct. I Signature of Assessor Date signed(month,day.flea
and complete.
Velh ig action-Signature of AWtor Oats signed(month,day,year)
•
,jiti�t_ -a = '- -. -�dGt '-VErnSTANDARD.DEDUCRONALCOWANCEr py-Tom`_ra
20 pay 20 Lesser of 60%of the assessed venue of the homestead or 545,000
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 bo a manufactured home that is not assessed as real properly may
not exceed one-halt(I/2)of the assessed value of the nlobde home or manufactured home.
5""//5r((is�oiIr1re of Audtw / Date signed(rurCh,day,lean
DISTRIBUTION Aud:ar,Fee-Stamped —Tapaye�(/