Homestead_Dawson (7) +r CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
�":34 1! STANDARD I SUPPLEMENTAL DEDUCTION FORM
:ti' . Sate Form 5473(R15/5-14) HC1O
i Prescribed by the Dew el of Local Government Finance
INSTRUCTIONS:See reverse side for filing insb dkins
NOTE:Telephone,Social Security driver's license,state identification and federal identification numbers am confidential under IC 6-1.1-12-37.
- .j.,.r- r .7--;."- .. 7/�.' CERTIFICATION STATEMENT..i'r- yr--r.. . f....., ,-i r: ,••I Me) shun[%'!� I � ' certify that I(we)occupied as my(our)Kin
place of residence or am(are)buying the following describe eal property under contract for which a Homestead Property Tax Sa dard
Deduction is hereby claimed on the date this application is gned, (date of signature). I(II, C 1
s
❑ Own. ❑ Am(are)buying under recorded contact 44
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. Cif
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pe Cy��vB�•it,: •,_.i .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. v'Y•Cott.."4",""
U Drying on=tact Fee Simple Mile's name
Recorder's office where contact is recorded Record number 1 Page
a?
c _ i'e 'x=Wrsciaci aTSvite''sT P,ROPERTY,oESCR)P.71ONaC'3>imil r rat 'f',C is
Catty Township 1 Tax`g c ,town,lwms5 )
ParmJ rumba Legal description Is the Min Putt
Real popsty ❑ Pmualy assessed modes home(IC 61.1-7)
If
any Wra1 the resEer-:al�'.x::xe a the land not exceeSxy one(1)acre that ismwdately . that structure is used to produce 4mme,des.-ibe the use and paam
of the poperty utirmed to produce income.
,/i7a-a -vaa. e37c? 9
PROPERTY OWNED ELSEWHERE BY CLAIMANT _ -, _- -
Sax,Corry,and Tonne Is claimant vacating a homestead?
' ❑ Yes ❑ No
Signor!-of claimant fl
I hereby certify the above statements are true,correct,and complete. i0 /
t i " . a•
Address l corral(master aid s`eK sty owe,and 21PCO e) Address of vacated •.- ..,d any(number and=set.dlc star •ZIP code)
t' 7o6 mlerii -
ASSESSOR USE ONLY _ I •ASSESSED VALUE HOMESTEAD VALUE • : IA
, NON-RESIDENL..•
VALUE 7.
Land not exceeding one(1)acts Immediately I(1) ry y 7` v n
surrounding residential Improvements _
Other land (2)
•
Total land(line f plus line 2) (3) _- - • - — --
Residential Improvements or Dwelling (4)
Annually Assessed Mobile l
Manufactured H ome Garage (5) r'.'-x.'�."
%"_t_.,;'2 t-
'
Other improvements (6)
Total improvements(line 4 through Tine 6) CO
Total value (line 3 plra line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(months day,year)
and complete.
Verifying action-Sgnauue dpantor On signed(mon day.year)
Ems. _ ''_g'sy'-yp-'yes,. ? eta` j.STANDARUDEDUCTIONALLLOWANCEre7j
te=
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Nohvithsariding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a motile 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(12)of the assessed value of the mobile home or manufactured home.
Signature of Nrdlor Or signed(ninth day,year)
DISTRIBUTION:Original-County Audloy Pie-ramped Copy-Taxpayer