Homestead_Masterson CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
_rc)i STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R15/5-14)
--- Prescribed by the Department of Loral Government Finance
INSTRUCTIONS:See reverse side for firing instructions.
NOTE:Telephone,Social Security,driver's ricense,state identification and federal identifcatkn numbers are m;fidenaal under IC 6-1.1-12-37.
I(We) certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signatu �e
):
❑ Am buying under recorded contract
❑ M(are)entitled to occupy as a tenant-stockholder of a cooperative j11�
housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. .
If buying on contact,Fee Simple owneya name
'Recorder's o3ce where contras a recorded • Record number (Page
Wr''—...,'^'=' ..11; x'si:g' 7.iMV7 `1PROPERTY,DESCRIPTION4° 3
_ County Township T ' amid(city,town tawns*)
Parcel number Legall desaipion Is the prone in n
questio
P/ 02 7 7"/a i/ G eel property ❑Annually assessed mobile borne(IC 6-1.1-1)
d any portion C.e•.ca or the land roeexceedg S!(1)aceturf itmediateN✓arttamia Cu[sNLaebused to produce income.describe hieureaand porion
of the d to produce income.
, —/O - 27- o0- oo / a/ 5 Qom /
• •' - ` ' PROPERTY,OWNED ELSEWHERE BY CLAIMANT '
Sam,county,and Township Is claimant vacating a homestead?
' ❑ Yes ❑ No
Signture of claimant
I hereby certify the above statements are true,correct,and complete. yj `n /) ,,(/ ��
Addr�of ratad(number and mom.rdlt Sate,and ZIP code) [ Address of vacated homesta(eadd,,, amts(nnumber end 9eet rsy,stab,end ZIP code)
ez48 & z50 5 Ckc,e JsQ u c 1t
ASSESSOR USE ONLY , I 'ASSESSED VALUE ' I HOMESTEAD VALUE I. • •,NON-RESIDENTIAL •
Land not exceeding one(1)acre Immediately (1)
surrounding residential Improvements
Other land (2) tit "N +5+:,:.�
Total land(line 1 plus line 2) (3) — - _ _
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) i• .` v 7 3 —
Other improvements (o)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plea line 7) (8)
I hereby certify the above is true,correct, I Signature of Assessor Dam signed(sacs day.year)
and complete.
Voting action-Signature of AUd for Date signed(month.day.Year)
''s?:.-- . .�i1..=rg 5S'ANDARD DEDUCTION•ALLOWANCE*: —:_,,:o y • ..may' -:-i?g;—c.,:F? �"
20 pay 20 Lasser of 60%of the assessed value of the homestead or$45.000
Notadhsanding 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-half(If2)of the assessed value of the mobile home or manufactured home.
Signabsre of Audtor Da signed(mom,.day,year)
C �`oNt ( Dam signed
/1-19— /F
DISTRIBUTION: Orignal-County Auditor,Fee-Samped Copy-Taxpayer