Homestead_Pfohl 1 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
cd Sate Fomi 54I3(R15/5-14) NCI
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for Wing instructions _
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under 1C 6-1.11 7 s
` - 4 I. "CERTIFICATION'-ST,AThMENT ' s, .:. '"2 T 7 r r'''�^='/"i P,1
I(We) Pre C `i/1//%t �/araci certify that I(we)occupied as my(our)principal
• place of residence or am(are)buying- following/scribed real p•—rty under contract for which a Homestead Property itai9aid
Deduction is hereby claimed on the•=te this application is signed, _ (date of signature). I e): iD7 '016
Own. ❑ Am(are)buying under recorded contract.
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ,, ••'filmy"! j
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified p d$S •
ry
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
•UDITOR
=
.�
L•b�ri,9 on comae Fee Slmpk owrcls name
Recyeh cc where contract is recorded • Record number 1 Page
- _i.:ingtrTt'.' ? W4PROPERTY.DESCwPiION' 'i ' rT�i't-"t r``e,—"Ile° = .+�
. County Township T : .QXd• •own,t. ..)
Pars)nut Legal desaip5on /
Real ❑A...ua%assessed mobile home DC 51.:-7)
C any pa' of the residerulst-fl ear the la not e=aroGpore(I)ems that immediatey thaterucere is used to produce income.describe the use and porn
of Me . ta ed to produce intccre.
% /6-.33— ao_ 00 67 499-0°1,/
u' - .. . I-PROPERTY OWNED ELSEWHERE BY CLAIMANT t • _ _._ .. -
Sa:e,County.and Township Is claimant vacating a homestead?
. ❑ Yes ❑ No
Signature of di .m / �
I hereby certify the above statements are true,correct,and complete.
Address of contactct(number and street dry,sere,aid ZIP c de) Address of vacated homes:a ,C any(number street riy,Nat,end ZIP code)
ASSESSOR O
E ONLYi ASSESSED VALUE tI HOMESTEAD VALUE;-
ifVONRESIDENTIAL
•_.VALUE' '
Land not exceeding one(•)acre Immediately r'="_°.' £;--17:;- -'i?,
surrounding residential Improvements (1) L-'-!—__ -== a'---/i.
Other land (2) s__.. __ . ^^.J
Total land(line 1 plus line 2) (3) -
Residential improvements or Dwelling (4) 1: `y 'I 7i,/,
Annually Assessed Mobile I rya s'x—F
Manufactured Home _ _
Other improvements (6) -
Total improvements(line 4 through line 5) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, S'e'an°°of Assessor Dare sign d(mash,day,yea,)
and complete.
Vs/ying adorn-Sigrature of Aud::m Date signed(month,day,year)
t--- •CSTANDARDDEDUCTION'ALLOWANCE I3:,N?„= ' ,u.'-'rr �'-eri ='4y -�°,1,
20 pay 20 Lesser of 60%of the assessed voue of the homestead or$45,000
AbM'HSandmg any other provision,the sum of the deductions provided in IC 6-1.1-12 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(12)of the assessed value of the mobile home or manufactured home.
Sign re of Astor Data signed(imnti day,year)
DISTRIBUTION: Origial-Coof.'yAUddor,FleSamped Copy-Taxpayer