Homestead_Lutz (4) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION FORM
Stab Form 5473(R15I 5-14) HC10
Prescribed by the Depamnent of Loral Government Finance
INSTRUCTIONS:See reverse side for filing insbucions_
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers am confidential under IC 6-1.1-12-37.
'.. -CERTIFICATION STATEMENT. . -.' .27Z-f-,F$T-. , .,r.,= i
I(We) Ia_ _a._ ! `F I / _a. I _ - i certify that)(we)o',. pi-.Ls ouri.i.:.,'
place of residence or am(are)buying the fol.. 'ng described real property undr- contract for which a Horn ead=roperty Tax Standard
Deduction is hereb y claimed on the date this application is signed, (date of si gLi a e O1u
❑ Own. El Am(are)buying under recorded contract CC
❑ Am(are)entitled to occupy as a tenant stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pets r l reside - -
o Am(are)the shareholder, partner, or member of the entity that owns the property.
{ =:
if buYi'g on contact Fee Staple v«xefs tare
Recorder's once where contact is receded Record number Page
•
R..rrit&^ 3_ ra±:-_f4 9a ri RIO-P RTY:DescwenON;ff g .
Carty 1 Township Taxing S ode(((city.town,1wnsh)a)
/V la 1,4L et CI lal,tt 4
Parcel mumbo Legal description Is the e9r
e property In m o
�} Ag /9 0 Real property ❑Annual).assessed retie home(IC 6-7.:-7)
if any paten of the resiferral otueae or the land not exceedrg me(1)acre that i tmedabN uixoutds that erumae is used to produce Lyme.descibe the use and oat=
of the property!thud to produce'recce.
°Z4 - a3 rat - 3ol - 6 oO .4, ?c -e09
_ - - PROPERTY OWNED ELSEWHERE BY CLAIMANT _
Sam Cony,and Township Is claimant vacating a homestead?
' ❑ Yes D No
grature of claimant,
I ereby certify the above statements are true,correct,and complete.
Andress of cm'ad(sunder and street sty:Sae,and ZIP cola) :l. n<L. l_AENess of vacated InneSsb t number area Stier,any,state,and LP code)
. ` - ASSESSOR USE ONLY • I ASSESSED VALUE” I HOMESTEAD VALUE : I NON-RESIS UENTiAL'
Land not exceeding one(1)acre immediately
.�.1Y
surrounding residential Improvements (1) 'tom--� f+.-tea
Other land (2) L • ...-__ ......_,....... .d._`I
Total land(line 1 plus line 2) (3) . _.
Residential Improvements or Dwelling (4) ' I a { -
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6) _ -��-' .,f_�, p._;o-t
Total Improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (CO
1 hereby certify the above Is ere,correct, Signature of Assessor Dab signed(month,day,year)
and complete.
Vetypng auon-Signatne eNdtr Data signed(math,day,year)
.+ - ":.nt >r' "s'�c STANDARD DEDUGTIONTALLOWANGE 'b3.""-�-`
20 pay 20 I eswr of 60%of the assessed value of the homestead or 545,000
NoMiMsanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
• that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(lit)of the assessed value of the mobile home or manufactured home.
signature of e‘(-7 �Je _ Dab signed(math,day,year)
DISTRIBUTION:Original Canty Ardda,Fie-Samped Copy-Taxpayer //)�/''`//