Homestead_Bailey (4) zr CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1515-u) HC10
Prescribed by the De ,tnem of Loral Govempnet Finance
INSTRUCTIONS:See reverse side for filing instructions. •
NOTE:Telephone,Social Security,drivels license,state identihpfion and fede.l identification numbers an confidential under IC 6-1.1-12-37.
.r;.-- - _ __ CERTIFICATION STATEMENT,'.`' ' •.{'c..-...: .
I(We) �1 • certify that I(we)occupied as my(o' n
place of residence or am(are)buyin/(e following described real property"er contract for which a Homestead Prope ail
Deduction is hereby claimed on th••ate this application is signed, (date of signature). I(We): b
0 Own. ❑ Am(are)buying under recorded contract 1,4
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ^1 p 9
ID Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trusty cop
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. G .
� „ :
If buying on contact.Fee Simple owner's name
Recorder's oft =sad where aad is recorded Record number 1 Page
ili 2eG#y_'s-PS,2" ,u--fT= ,' > P,ROPERfi:DESCRIPTO4 z °..ice... '-.. - . -:.d _ zh-
Cowry Township / (city,town,townsh4ii
• ed to
Parcel number LL//�¢JJ/,a/ry/lea n /�/ " is the pet tri quest:
rare �`r �g �property ❑Pmual)assessed mobile borne(IC 61.1-7)
If�of the residential maraca or the nd exceei-,g ae(1)acre tat'mmed2.e1y sunamds that Y udwe b used to produce income.describe the use and palm
of tacked to produce tho�m1-e. /' ,1
Ol '/3! / �o2-O6 U.076 - Oat
- PROPERTY OWNED ELSEWHERE BY CLAIMANT - _ . . _ - -
Box.Carty.and Township Is claimant vacating a homestead?
' ❑ Yes ❑ No
.. .-re of claimant
I hereby certify the above statements are true,correct,and complete. ,_
balms of contact(minter and street 7.Cate.and LP code) AA1Ps d vacated hmaeread,a any(number and s reet rdy.eae,and ZIP code)
a s. 4 CI -;_..c S e e. I ,-
ASSESSOR USE ONLY ;I ASSESSED VALUE HOMESTEAD VALUE ; NON-RESIDENTIAL '
VALUE
Land not exceeding one Nacre Immediately I(t) -- - -- - ---- - -�-'
surrounding residential improvements
Other land (2)
Total land(line 1 plus line at (3) - — . _ _
•
Residential Improvements or Dwelling (4) I
Annually Assessed Mobile/
Manufactured Home Garage I(5) _ I _ 47.%.7--,-- P
Other improvements I(6) I _ �__',-
,
Total improvements(line 4 through line 6) I(7)
Total value (line 3 plus line 7) I(6)
I hereby certify the above Ls true,correct, I Signature of Assesses Date signed(month,day,year)
and complete.
Verifying actin-signature ofPoStr Date signed(month.day,year)
'r,_ '_: STANDARO DEDUCTION'ALLOWANCE ..-- -4 ,erV1:
20 pay 20 Lesser of 60%of the assessed vkue of the homestead or 545,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real properly may
not exceed one-half(1R)of the assessed value of the mobile home or manufactured home.
Signature of Podia Date signed(north,day,year)
DISTRIBUTION:Origial-CounyAud::oe,,Fla a-Samped Copy-taxpayer