Homestead_Purcell 41144= CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
tit?) STANDARD I SUPPLEMENTAL DEDUCTION FORM
Statte Form 5473(R15/5-14) HC10
Prescribed by the Departnent of Local Govrrcv Fiance
INSTRUCTIONS:See reverse side for filing instructions )
NOTE:Telephone,Social Security,driver's license,state aienlificatan and federal identification numbers am confidential under IC 6.1.1- 7.
i^ 4 -,'•` ' - �- .. CERTIFICATIOP.STATEh1ENT •. •CTT } .)_:,-- ;�y^1
I(We) il�V nL��i����y certify that I(we)occupied as my1buc/1��p�nnapal
place of residence or am(are)buying thfollowing described real property under contract for which a Homestead Property ItDgotand -cl
Deduction is hereby dawned on the dat- • is application is signed, (date of signature). I(We): 7 ?!/g
❑ Own. ❑ Am(are)buying under recorded contract U
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. CIeS ff��,,,�
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personalreaAdt, i?lPl,er'
s
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. YA
U.I
If buying on mNaq Fee Snple owner's name
Reorders o5ce where contract O receded I Record number I Page
.W. trYr-S_ .: _..Y -. _.."a.°-PROPERTY.DESCRIP.TI0N'E.r•4..�: n- wss-t. '4IP_ 3
•
di.
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et 08-22
Parcel 4, the. • ryin quesixx
/`! ' �r1 '� ` .(/ ` I. Real Popery ❑ Annually assessed mobile home(IC 6-1.1-7)■
II any portion of the residential stroure or the .rid not exeeed:-g one(1)acre that Web), • • • that ervouas b used to Produce bane,descae the use and portico
of the Poperty aired to produce income.
�(�
orZ`r 3/6 o?OV • ooa.�a US- 6 171
•
. , PROPERTY,OWNED ELSEWHERE BY CLAIMANT : ' - ..
Sri,Carry,and Township Is claimant vacating a homestead? '
❑ Yes ❑ No
Sgnxoe of dearer¢
I hereby certify the above statements are true,correct,and complete. j (C r + n.,t, . .WI
of conaG( .sueeb o1Y.- •ZIPaide) Address of vacated homestead,i any((n"mumber` end aaeet dx state code)
4 0 �4 .-. ' I a .. .:b. �' 4- =c-N 6•L% ` ASSESSOR USE ONLY ASSESSED VALUE., I HOMESTEAD VALUE ii: S, 'NON NON-RESIDENTIAL 0
Land not exceeding one(1)acts Immediately
surrounding residential Improvement I(1)
Other land I(2) t^_ ..i L'•-::,z�•�:,
Total and(line 1 plus line 2) (3) I —
Residential improvement or Dwarfing (4) I
Annually Assessed Mobile/
Manufactured Home Garage I(5) _ I r :t
Other improvements (6) I. - ___- - -- , _
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits fine 7) 1(8)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month day,year)
and complete.
Verifying action-Signature of Auditor Date signed(rah,day,year)
t''-,- "-=75 ==: .STANDARD DEDUCTION'ALLOWANCE' v_-'. Via'`---
20 pay 20 t asset of 60%of the assessed value of the homestead or 545,000
Nvhsiihstanding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home 5
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(112)of the assessed value of the mobile home or manufactured home.
Signature ofAUd or Date signed(nere.2 day,Yee)
DISTRIBUTION:Original-County Auditor,Fiestamped Copy-Taxpayer