Homestead_Reeves _ CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
`
STANDARD I SUPPLEMENTAL DEDUCTION OR
State Form 5473(R1515-14)
/ Prescribed by the Depamnem of Local Government Finance '
INSTRUCTIONS:See reverse side for tiling instructions
NOTE:Telephone.Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
�... -� -n _ •••y CERnFICA'DON STATEMENT_ :-,�s -.. s - .5_%":�-,.:.;
I(We) A ! ' I a certify that I(we)occupied a-in ptpeipal
place of resi•ence or am(are buying the following described real pro f rty under contract for which a Homestead P.;.e T ndard
Deduction is hereby claimed on the date this application is signed, - _ (date of signature).
❑ Own. ❑ Am(are)buying under recorded contract DE
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. C
El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence tftSStr. s
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. /
+=
If buying on contract,Fee Simple owner's name
Recorders ot5ce where contact is recorded Record number Page
A
=,/s ___53_ .t ; PROPERTY:DESCRIPTION'._.'- mayn.- w _
—Is the pm coquestion:
��� 1`•9 : :.!1 =Real property ❑Annually assessed noble home(IC 6-1.1-7)
d -- -rbl r.-.rcae r the la • .. _ - acre th - m:et is used to produce income,describe the use and portion
One ace= _.-p.. ) .��- prod
ofMro• �ced to rpdu¢'eaae. 4 r'
(lo - /9 0/- 60 - 600. �/—QG 1
- E- -
1� PROPERTY OWNED ELSEWHERE BY CLAIMANT -� ,_ � _
sa"Coumy,and Township Is claimant vacating a homestead?
- ❑ Yes ❑ No
I hereby certify the above s3tements are true,correct,and complete. e �•
dun/ .. /
Ni.,Address of Gonad(number and street,d�yJ st"ab,end ZIP=de) 14 FI H 1355,1 7- -' -—,,d ho es ead.- any number and street rayy, LP code)
e617.1-41 ..2a - L1. sr/ q76�- .. - .
ASSESSOR USE ONLY _ ASSESSED VALUE I- :HOMESTEAD VALUE ' .I NON-RESIDENTIAL
VALUE.
Land not exceeding one(1)acts Immediately (1) 'i - - '�—'p
surrounding residential improvement .. _L.,__ -_ _..-,,,_„.
1- fi.- e::
Other land (2) _..:-"f.,.v _..._x..:.r
Total land(line I plus line 2) (3) - _ ___.- .
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I Manufactured Home "F'°_
Garage I(5)
'S.:.'7: -. -r'
Other improvements (5) _
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) I(6)
I hereby certify the above is true,correct, I Signature 0:n Date signed(month,day,year
and complete.
Vedyrg action-Signature of AW:tor Date signed(month,day,year)
mss -_-.F.-. �.-A ,- hc- ?STANDARD DEDUCTION'ALLOWANCE --a:ate alt',u�_,a y� ,t
20 pay 20 Lesser of 60%of the asaacted value of the homestead or$45,000
No:wit/Wending any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home $
that is not assessed as real properly or to a manufactured home that is not assessed es real properly may
not exceed one-hai(12)of the assessed value of the mobile home or manufactured home.
Sgrns ofAUd::or Date aigred(mond),day,yew)
DISTRIBUTION:Original-County Auditor,Fie-S gimped Copy-Taxpayer