Homestead_Sparks (4) 0-ter ' CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD(SUPPLEMENTAL DEDUCTION
�� Sate Form 5473(R15 1 5-14) HC10
Prescribed by the Depatnent of Loral Government Finance
INSTRUCTIONS:See reverse side for filing instructions i
NOTE:Telephone,Soda/Security,driver's license,Sate identification and federal identification numbers are°s nden'-t. set i • i.1-12 ■ .'',
ice^(//.•�� 1 _ _ - 'CERTIFlCATION STATEMENT-.!';: . .: ') e, ''LZ (.� ")-F:?j 1 Iv)r.
I(we)'17 e'/i9.Ragr e i e. 1 !a •TW P certify that I(we)occupied as my(our)principal
place o residence or am(are)buying the following descri•-• real property under contract for which a Home ,�p7'r pe�y ,tandard
-DDed/uuGion is hereby claimed on the date this application is signed, (daterof sgnaTuie`}. �(WeT):
(]YOwn. ❑ Am(are)buying under recorded contact
❑ Am(are)entitled to occ� y as a tenant-stockholder of a cooperative housing cc
( P Pe g rpora5oG I r' 9�/Ii
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms otnegbZ cotJ y •-• A.e •-i'FOR R
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
-+..
.,. ..-
L`tuy4p m=east,Fee Simple ewrefs came
Randers o3ce where contract is recorded - 1 Record number I Page
- , J"=7ge -117n br'--F.'�.- "4irr :t2' sari `PROPERTY,DESCR(P.T(ON I '—'• ;.'.,0 —i' - .-
Caurry Township Taxing dstcf(ray,town,township)
Parcel number Legal deatipton Is the property in question:
❑Real property ❑Amua%assessed=tee home(IC 5-1.1-7)
If any paten of de residential sdune or me and not exceedmg one(1)acre that'n r.ed'Y.ely surrounds that structure is used to produce income.describe the use and portion
of the property team to produce ircane.
a(- 1g-36- Soo- ma. 104b-or
S,Yts,Casey.and Township Is claimant vacating a homestead?
❑ Yes ❑ No
re of damnare
I hereby certify the above statements are true,correct,and complete. (/i-,c / (y<Th I1�/rs
i.- IV` r U L (er est I 1J
Address dmm G(numterud greet,� .#ab.and ZIP code) - -.tress ofvaatMfumeCead.Rany NumlwrYridy['+astray Sett,and ZIP code)
I b to ) S Ili- o, Q t c7ssci - t fbStac(t IA) u`) 02
.. ' ASSESSOR USE ONLY • 1 ASSESSED VALUE' I 'HOMESTEAD VALUE) FL,NONRESIDENTNC
VALUE '-
Land not exceeding one(1)acre immediately
surrounding residential improvements I 1) I -� - '° - '
.it _-3)!:'>-_ n
Other and (2) .` .
Total and(line 1 plus line 2) (3) _. . . _ _
Residential Improvements or Dwelling 1(4) I
Annually Assessed Mobile/ v ��.�(••
Manufactured Home Garage I(5) • I T - .._
s, ': 7.-. t.- -C
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 piss line 7) 1(8)
I hereby certify the above Is true,correct, I Sgnatue of Assessor Date signed(month,day,year)
and complete.
Vetting anion-Signature of AW'ior Date signed(maim.day,year)
s- `SsGFPrc` �,.- -STANDARD DEDUCTION'ALLOWANCE's �-` i,',,T --' i �__, y .,W's:j
20 pay 20 Looser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not exceed onnlee-hhaalf f(7,2)ofthe value of the mobile home or manufactured hone.
Signature of`�ir• —_-_as {tl De's[.-red(9 acct,year)
pit)DISTRIBUTION:Original•Camty Audda,Fie-Stamped Copy-Taxpayer