Homestead_Anthis (4) .. CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
V STANDARD I SUPPLEMENTAL DEDUCTION HC70
�_�� State Form 5473(R15/5-14)
Prescribed by the Deparbned of Loral Government Finance
INSTRUCTIONS:See reverse side for tiring insauctibns
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
- _ ‘ - - -`I CERTIFICATION STATEMENT ') . . - :'el 7 1<-s !� `'_•
I �� OnirLS certify that I(w I ed IN r %
pi la .. __._.. are • fing the following described real property under contract for which a • es I I-• •
ddon is hereby claimed on the date this application is signed, (date of signature) I(We):
SI Own. ❑ Am(are)buying under recorded contact NOV 9 2016
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the bust or the right to occupy the property under the terms of a qualified •- •nal re 'den.: trust
ID Am(are)the shareholder, partner, or member of the entity that owns the property. I/ , WI-Il
If buying on contract,Fee Simple owners name
Recorders cSre where contract is recorded Record number Page
'"T'-(SB j '-4 ems.t .e -,.. - _ -
_Y�- -t- .'i_�<= y ^- P,ROpERTY,DESCRIP,TION°'.-21 ail- ��W!- >_-^ bid:._ ---
Cary Township 1 Tasty deVri(dry,towir, mtap) /�
Parcel number Legal description Is the`/ roc property/] es question, )/J�~P�
I wopeoty ❑Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residerevl cm ..ce the land rot exceeding one(1)ate
that immediately surrounds that=care is used to produce income,desate the use and poi
of the propeny utilized to produce income. to-a5 J
o a 9 ce5 07 .457 Pie?
•• . PROPERTY OWNED ELSEWHERE BY CLAIMANT ' _
Ste,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
SlgraNre imam '
I hereby certify the above statements are true,correct,and complete. y>c7 ! ti
Address of nomad(number and stem, state, vacated e,end ZIP code) of vad hornet/sad.d any(number end Mee( • ,and ZIP code)
05-353 AU 75' C Phkajt/ `1766.6
•
ASSESSOR USE ONLY ' ( ASSESSED VALUE • I . HOMESTEAD VALUE I' - NON-RESIDENTIAL
Land not exceeding one(1)acre immediately -
surrounding residential improvements I(1)
Other land (2)
Total land(line 1 plus line 2) (3) _
Residential improvements or Dwelling (4)
Annually Assessed Mobile) - -"
Manufactured Home Garage (5)
Other improvements (6) » 'tc 3
Total improvements(line 4 through line 6) I(7)
Total value (line 3 pits line 7) 1(8)
I hereby certify the above Is titre,correct, I Signature of Assessor Date signed(0.00*day,year)
and complete.
vetting action-signature ofAUd'L.tor ; Date signed fund,.day.year) '
0-`lz.W{_--#'-:SC•,-_> y= ?t sterl..:.Stia ;� iSTANDARD DEDUCTION'ALLOWANCE'54, '
20 pay 20 I Pscer of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other pmvision,the sum of the deductions provided in IC 6-1.1-1210 a mobile home $
that is not assessed as real properly or to a manufactured home that is not assessed es real property may
not exceed one-half(12)of the assessed value of the mobile hirne or manufactured home.
Sl` \Jn[na t.(JA/�/) Data signed(mad;day.Wed
DISTRIBUTION: Odgnal-Carty Azat .Fie-Ramped Copy-Tauvyer