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STANDARD/SUPPLEMENTAL DEDUCTION
T N FORM YEAR
o 'I`' State Form 5473(R15/5-14) HC10
Prascnb_d y t`e Depaanw of teal Government France
rill
INSTRUCTIONS:See reverse side for firing instructions 4•
NOTE Telephone,Social Security,driver's license,state identdicadon and federal identification numbers are confidential uncle(IC 6-1.1-12-37.
°`GERTIFIGATIONSTATE6IENT_• i• ii ' . - :a.
I(We) � //%1.Ci .fe � certify that I(we)occupied as my(our)pn 4 rs•
place of residence or am(are)buying the Poll"' g de •.•-• real property under contract for which a Homestead�P'r�o'perty T- Standa•/ �,
Deduction is hereby claimed on the date this application is signed, (date o SQ41,l(a) 1 ) 1/
Own. ❑ Am(are)buying under recorded contract 0/fr C - 4
❑ • (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 004 ' ))eo
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a guard—led personal residence trn+sifq .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. _ 'I Qi�•O
=.
If buying on cataract Fee Simple owners name
Recorders o5ce whets ratan is recorded - Record number I Page
astir°
ie'I���� �=a?r�..��a�aiPROPERTY,DESCRIFTON'� /�, .�..�' F' _d?�,�
Parcel number r•.al dew•: tre 4.3 6 Is thegIIperty in question
1/ /A) g \`J�[`,J{Real property ❑Annually assessed motile home(IC 6-1.1-n
C any poraon of the msideral-..Coe or the end not exceed-no one(1)aDa that ode that=crate is used to produce income deacibe the use and pardon
of tie property udized to produce became. -
ao-a/a 36,?-cop.30S lid 0
., ., :PROPERTY OWNED ELSEWHERE By CLAIMANT _ 1".:__i.--,-,.- - ..- ,.i, .',
Sats.County.and Township Is claimant vacating a homestead?
. ❑ Yes ❑ No
•
Sigvhnre of claimant
I hereby certify the above statements are true,correct,and complete. ,/ " _
Address of correct((umber and steel.a)•,gab,end ZIP code) A.idl` +oflncatted/tnrreertad.C any(number end ipm( t ,sid ZIP code)
ASSESSOR USE ONLY ' ASSESSED VALUE I. HOMESTEAD VALUE t I 11' NON-RESIDENTIAL
VALUE .
Land not exceeding one(1)acre Immediately T t-<s�,.�.••--I":
surrounding residential improvements (1) _'s 3- �
Other land (2)
Total land(line 1 plus line 2) (3) I — --
Residential Improvements or Dwelling (4) I p ' '
Annually Assessed Mobile I 6 }.•., !
nn
Manufactured Home Garage (5) I .._- ° .• .- . ,_.__
Other improvements (6)
Total improvements(line 4 through line 6) (1)
Total value (line 3 plus line 7) (6)
Ind coy plete. the above is true,cort¢ct Sgv:urc of Assessor Date signed( � a d-1 ye
and complete.
Vayig aeon-Signature IN'Y.d.tof t
'•-y. ' STANDARDDEDUGTION ALLOWANCE �•1'�. .- rr'Ea 'j7
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notarthstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S •
Nat is not assessed as real property or to a manufactured home that is not a4444444 as real property may GIBSON ir��l
not exceed ne-haft(laid the assessed value of the mobile home or manufactured home. BSON Cn
Gera signed(nnorut err.rear UNTY 1 UDITOR
(PA iu 3-03-/7
DISTRIBUTION:Odgral-County Auator.Fie-Samped Coy-I