Homestead_Debenport .� " CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
>y_ FORM
STANDARD/SUPPLEMENTAL DEDUCTION
<v. < State Form 5473(R15/5-14) HCTO
Prescribed by the 0emnert of Lo al Governsera Finance % 1
INSTRUCTIONS:See reverse side for Ong instructions.
NOTE:Telephone,Social Security,drive/s license,state identification and federal identifoato numbers are confidential under IC 6-1.1-12-37.
' -„• . �• �' .'u[, --�' --.,• -`.,CERTIFICATION STATEMENT- ' ' ••��: ',
I(We) ll riTlTir�� / ♦ ..7 �ii.r i..ffin certify that I(we) (our nn ie) 1
place of residence or am(are)buying the following described real p• - under contract for which a Home d Tax a •''
Deduction is hereby claimed on the date this application is signed, (date (sign u
Rt,',•,,• ❑ Am(are)buying under recorded contract •
(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. NOV 1 4 2016
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal rest ence trust .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
;1./1` 11 .:
If prying on contract.Fee Simple carets name
Recorder's office where contact Is recorded Record number Page
-Mrr a- T'$at....t<-_ :;-17.`?i z3:&_z-5:RS,PROP.ERTY.DESCRIP•TION3,^.'SR�_v ° 4Y...-si*'==YirrefirrAi_a+� .
Cast/ Township Taxing district( fo�wn// // .y)
Parcel number Legal desaicaon Is tl!!!!!!���eesprppr�r m^quescicor
Meal property ❑Annually assessed rouble home(IC 6-1.1-7)
If any portion of the residential ttce or the land not exceed s%one(1)acre that immediately surrounds that studure is used to produce income,desa,ee the use and portion
of the property u hazed to produce home.
a4p /-7-0 / - )f CO � /S/ - oaj
-
j- - ' PROPERTY OWNED ELSEWHERE BY CLAIMANT- - - - - ••
State,Carey.and Trvmat ip Is claimant vacating a homestead?
. - ❑ Yes ❑ No
ISiguture am
I hereby certify the above statements are true,correct,and complete.
Address of sonata(number and.Oeet ary,shah,and ZIPmde) Address of vacated homestead,d any(number end s5eet.OD:sLee.and 71P code)
Sid• ,.� QwE»Sv)4c n{ 47(x$
ASSESSOR USE ONLY .I' ASSESSED VALUE I'.I • HOMESTEAD VALUE I NON:RESIDENTIAL
Land not exceeding one(1)acre immediately < <”
surrounding residential Improvements (1) — - =
I 14-.
;e..`r- -.yT.^$/,_
Other land (2) �.. _.•v t�...
Total land(line 1 plus line 2) (3) _
Residential Improvements or Dwelling I(a) < -
Annually Assessed Mobile I
Manufactured Home Garage I(5) _ I fL_
Other improvements (6) ` t`i.a—r•'-71;
Total improvements(line 4 through fine 6) CO
Total value (line 3 pits line 7) I(8)
I hereby certify the above Is true,correct, I Signature of Assessor Da x signed(L°nth•day yew
and complete.
Vadytg entice-Signature ofAuotor Data signed(month.day.yea)
__ `.eaiti_gP�-� .]�_-141STANDARD DEDUCTON'ALLOWANCE- W[J i�}�
y_�iLa'.• _.��eaYa:-.'.i.3�a'�d• �..1�.•-�_.a_ _�_ i4s3.s-4"��.• M_'�3lat-y_-is4Mr_
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Nobynlcending 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 to a manufactured home that is not assessed as real property may
not exceed one-hall(12)of the assessed value or the mobile home or manufactured home.
1 Sigrutre of or Data signed(moth day.yea)
ill
DISTRIBUTION: Original-County Auditor,FdeSzmped Copy-Taxpayer