Homestead_Graham CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR
'Pr STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sate Form 5473(R15I 5-14) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE:Telephone,Soda/Security,drivers license,
property under contract for which a Homestead Property Ta> Prtlap 2016
Deduction is hereby darned on the date this application i .igned, (date of signature). I Mgr 3
❑ Own. ❑ Am(are)buying under recorded contact
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. tie 41111jjr
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified persc ; .0,1:'•-•: .
El Am (are)the shareholder, partner, or member of the entity that owns the property. N ?AUDITOR
_
'�
tl buying on contract Fea Simple arrehname
Recorders office where c etso is re-,do-1 • I Record number Page
ZAK741i_1-7 = °.1]PROPER ,DECRIPT O-Nn'1 -1::. '°'F•i. St
County Township 1 Tax r(city f n,IcwTelm) 77
Parcel number Legal desaiaion / s the rty in quesboct
Real property ❑Annually assessed mobie home(IC 6-1.1-7)
dp4 ponen of the residenual=ere or the land not execs:fg one(1)acre that ir._meda:ey arm that stinae is used to produce income,des:ibe Coe use and podoi
of //oo,aoeerrr111yfyvv tt icd to produce incx:e.
c�G-aa/o- /O 000. Dos-Oct/•- _ - PROPERTY OWNED ELSEWHERE BYCLAIMAM- - , ,• • ,__ ,_ . s -
Saet Corey.and Texnshtp Is claimant vacating a homestead?
❑ Yes ❑ No '
SiguWre of claimant (�
//.�L��l I hereby certify the above statements are true,correct,and complete. ✓� _ n n s )) -
f ` Add'eas of=mad(nr,>nber end street.Mystery,end ZIP code) r 7639 (Add`ress of vacated ho estead,i any(number and Y freett city,state,and ZIP code)
7\ 1i3a5 SOwc.. s ,1 £ 'A, . au.ss • f •' ASSESSOR USE ONLY t • l, ' :ASSESSED VALUE I HOMESTEAD VALUE •,I J.NON-RESIDENTIAL
VALUE
Land not exceeding one Maus immediately '• .•
surrounding residential Improvements I(t) I .. ,_ _ ..k'_-t' " : `
Other land (2) ...rte .._.....:.._...• a.
Total land(line 1 plus line 2) (3) - - • _ -- --
Residential improvements or Dwelling (4)
Annually Assessed Mobile l
Manufactured Home v"'•
Garage (5) T': > 7_4
Other improvements (6) ___.._. . ..'.,'_-_ :'f#
Total improvements(line 0 through line 6) (7)
Total value (line 3 pica line 7) (6)
1 hereby certify the above Is tee,correct, I Signature of Assessor Date signed(month,day,year)
and complete.
Vetyty aeon-Signature of Auditor Date signed(month,day,year)
E.ia:. `-,s"�y--"-T"- W-y.'YISTANDARDDFDUCTION'ALLOWANCE ' -' '�3" -�D°i 'Vc.
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other provision,the cum 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 that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Signature of AUddpr Date signed(math.day,year)
DISTRIaUTION:Original-Camay Amdsn Fie-Stamped Copy-Taxpayer