Homestead_Kissel (3) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
di STANDARD I SUPPLEMENTAL DEDUCTION FORM
Sate Form 5473(R15/5-14) HC10
Prescribed by the De anneot of Local Govermera F
INSTRUCTIONS:See reverse side for filing instructions •
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NOTE:Telephone.Social Security,driver's license,state identdi acton and(Sem(identification numbers am con5denilal under IC 6-1.1-12-37
- -'- - :• / �.�RTIFICATION STA7F37ENT_..f-.__ ' - ?- _ •`'"T
I(we) •• / - d. fL�1Z+L cerh(y that I(we)occupied as oust(o • f I
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Sta n -
DDeduction is hereby claimed on the date this application is signed, (date*rata -1 a): /f6.•
75.1 Own. ❑ Am(are)buying under recorded contract. SOH 4.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. COO e ..
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residenla� .
❑ Am(are)the shareholder, partner,or member of the entity that owns the property AG•
__=-
C burying on contract,Fee Simple owner's name
Reorders oSa where mrtad is recorded Record number I Page
`St y-Z Wir g'LIfitk' PROPERTY,DESCRIP:O _ gTy'? �=- 4--
TvmshP figt;(0y )
O/ —
Partel camber deeee�rsc//ri/^ip����tion// tie igta is
. ,/ c_757-62_1/ Real properly ❑Annually assessed=tie hoe(IC 6-1.1-7)
Cm�of the resideRal strvCm or dre bed not ezmedsg7X%Xas(1)sae tlatim a�N§r .cis Cat slraure is used to produce income,describe the use end practice
of t ty utilized to produce i come. .J 1/7../
076/ids 6-000,6- 2-601-7
_-. . - _ PROPERTY OWNED ELSEWHERE BY CLAIMANT - .- _
Sate,Cuvsy.and Township Is clamant vacating a homestead?
. ' ❑ Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. 4 457.42_-r ct
A�of commit(number and sreet ray,ewe,and ZIP code) dress of vacated homestead,if aM/(number and Cruet dry.tae.and ZIPcode)
7/1 w 3oo 5 erincM IV `17670 •
• ASSESSOR USE ONLY I • ASSESSED VALUE. I HOMESTEAD VALUE I NON VALUE AL
Land not exceeding one(1)acre Immediately g
surrounding residential Improvements I(1)
Other land (2)Total land(line 1 plus line 2) (3) - _ -__ .
Residential Improvements or Dwelling (4)
Annually Assessed Mobile 1 -
Manufactured Home Garage (5) ' -H')
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Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature or/ssm Oate Signed(ounce,day.year)
and complete.
Verifying scion-Signature of Pastor Data signed(month,day,year)
�s ts_`-4 %' "-r-i. raalSTANDARDDEDUCTION'ALLOWANCE'+ -- s/bar..': ;tl4.-i-1
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
i Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real properly or to a manufactured home that is not assessed as real pmpery may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Sgretre of Aud:or Date signed(month.day.year)
OI5TRISLrfON:Orgial-County Audtor,9eSamped Cop'-Tegayer