Homestead_Loomis r .% CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
tit STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Fonn 5473(R1515-14) - HC1 O
Pre:embd by the Department of local Government Finance
INSTRUCTIONS:See reverse side for abrg instructions. •
this application is signed, - (date of sigr$l r . 54):2016
ID Own. E1 Am(are)buying under recorded contract U
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
ID Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pe •if,.y.: -fil,1 7p.
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. ; ON COUNTY AU ITOR
:.
If buytg on contact Fee Sipple comets name
1 Recorder's office where contract is recorded • I Record number Page
r:tCe .3.-_e °1.. °d' '--' 'F' -°JG�� aPROPERTYiDESCRIPTION °•._t`s' °iti._.ts.:--�y�^3''x'e-rm- fn
Lotary
Township Taxing d5d _
'Pa J number a Legal desaipton 6 o. ,e 7 a- Is the property in cues-bon:
�l t w N_F Ncv f( -d - 6 ❑Real property ❑Annually assessed metre borne(IC 61.:-7)
If arty paten of the residential stature or the land not ex eecf g one(1)ace that bamdiate y surrounds that stnpofse Is tad to produce income.describe the use and portion
of the popery mated to produce game. 2
. G - /a -a _boo -ODD . 3 9 $ -0017
.. .
. _ PROPERTY OWNED ELSEWHERE BY CLAIMANT . - -_ _ •
Sam.Coaay,and Township Is claimant vacating a homestead?
' ❑ Yes ❑ No
Sight-ire of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,of):slate,end ZIP code) Address of vacated homestead,if any(number and street Cy,slate,and ZIP code)
ASSESSOR USE ONLY I . ASSESSED VALUE I HOMESTEAD VALUE 'I NON-Ry SIDENiIAL 'r -
Land not exceeding one(1)acre immediately
surrounding residential improvements I(1) ., „t... s
_r I,_ ,y.:'-
r ,-ir:
Other land (2) I4 P'ta: iv °.:,..: ti..
Total land(line 1 plus line 2) (3) I — --_ -
�_.
Residential sassed Mobil or Dwelling (4)
Manufcture Home MohOel _ . _ _ _
sWnufachrredHoma Garage I(5) d. __ •-.. .-u ! °°irz
Other improvements (6) y4. _- .z .
Total improvements(line 4 through line 6) I(7) I
Total value (line 3 plus line 7) 1(8)
I hereby certify the above Is true,correct, I Signature of Assessor Date signed(r:°n:h,day year)
and complete.
Verifying action-Signature of AUdtor Des sign(month day year)
.- -.r :-_ G"-y= STANDARD DEDUCTION'ALLOWANCE_>_ _ ;- ..5tC. `—�'i, '.»;I
20 pay 20 Lesser of 60%of the aswassed value of the homestead or 546,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.7-12 to a mobile home $
that is not assessed as mat property or to a manufactured home that is not assessed as real property may
not exceed one-hall(12)of the assessed value of the mobile home ormanuladumd Mme.
% ye dpudcor s (A. .... �/��( � Data signed(month,daY.year)
DISTRIBUTION: Origia odor,Fie-Samped Copy-Taxpayer `/// //