Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
Homestead_Gries j~Y- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4
STANDARD/SUPPLEMENTAL DEDUCTION FORM
d. Stare Form 5473(R15/5-14) 11C10
Prescribed by the Department of Local Gomuneni Fiance
INSTRUCTIONS:See reverse side for tiling instructions
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confid:.d- n.- C 6-1.1-12-37.
• 117 _ _ CERTIFICATION STATEMEN i- r r 1 'i a?i .6 .
I
(We) 4 t / �i..d...._4 certify that ' _e). 1 . i o r)if:-I
which place of residence or am(are)buying the fol owing described real property under contract for w a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (clan p(pigppt e:
❑ Own. ❑ Am(are)buying under recorded contract ffllCl, L �)2� )
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. n,
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a quafiYaq perso - t .
❑ An (are)the shareholder, partner, or member of the entity that owns the property. J�(t'
G . • • .
`-
If buying on=art.Fee Sim*e waxrs name
Recorders o5ce where contract is recorded - Record number 1 Page
n r_- ECri %-=%'_`1 ? ..zT4 Z: kaP,ROPE2W-DESCRIPTION � '°`nsi--Y- aaayy- '� 'c- ni:' i;
Couny Township Taxing deg(sly,I. ,foantNO)
Parcel nu-nbet Legal detaipon /s the property in ques]ort❑Real property ❑Pnnuaiy assessed'noble home(IC 6-1.1-7)
•
Cary portico of the resider^ul comae or the land na exceeS-p CO,(1)aae tat"v.::edately strands that Staten is used to produce income,deambe the use and eocico
of the property utilized to produce Siwre.
01 6 - A3 -0/ -026.0 - 000. q) 0 ro .l'{ •. • PROPERTY OWNED ELSEWHERE BY CLAIMANT •. -- . - _
Sao,Casey,end Township Is claimant vacating a homestead?
' 0 Yes ❑ No
Ali/ re a claimant
7�LLLJ`LT.1l0tJ
I hereby certify the above statements are true,correct,and complete. Jr
of mYaa(number ad steel,r>iY.state,end ZIP code) Address of vaar2dlmeeal,L any(number and s'rea,dry.gee,eMZIP wda)
•
35e - c :.. .- - mac ! -*Sr_ ■ e
ASSESSOR USE ONLY I - ASSESSED VALUE I .HOMESTEAD VALUE .y I t•NON-REVASIDENTIAL'
LUE
Land not exceeding one(1)acre Immediately
surrounding residential improvements (1)
Other land (2) '.L.J�r_-•-_ _
Total land(line 1 plus line 2) (3) - - . - _ _______ _
Residential Improvements or DwellIng (4)
Annually Assessed Mobile l y_ .--r.
Manufactured Home Garage (S) °
Other Improvements (6) t �J- art
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above Is true,correct, I Signature of Assessor Date signed(moNA day,year)
and complete.
Verdyiug action-Signature ofAUitot Date signed(recta day.yew)
' ._
-_�:'.+^;-. _ s��p -�.-T, t—'�'.STANDARU'DEDUCTION'ALLOWANCE 20 pay 20 I eccer of 60%of the assessed value of the homestead or 545,000
Notvei.hsianding 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-haif(12)of the assessed value of the mobile home or manufactured home.
of Signature Date signed(math,tier.year)
? r'<'t-
DISTRIBUTION:Origi al-Gamy Mid mped Copy
