Homestead_Reed (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r- STANDARD I SUPPLEMENTAL DEDUCTION FORM
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Sate Form 5473(R15/5-14)
Prescribed by the Depaynenl of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. -
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-1231
. , e' _ ',CERTIFICATION STATEMENT;T h�iC r - cs C- . - =J;.
I(We) x _I 4- &.Cc-4 -C2 -i certify that j„-) I I®`, , out .?pal - .
place of residence or am(are)buying the following described real property under contract for whi• e o .- - '•and .
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract MAR 8 2017
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a quali -d personal resi•ence t st
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. Mitt'
_
If drying on conYaa,Fee Simple ownees name
Recorders ofnce where curt as is recorded • Record number 1 Page
e. ^`� W - PROPERTY.IDESCRIPTIONG 4--"T n`?= cP
County Township
I I . ,
Parcel number Legal description ,Is the property in questrory
/,,ea,,, , 490.4- 9/0 -Real property ❑Annually assessed mobile home(IC 6-1.1-?)
If any portion of the residential str re or the land�/not t�exm∎edi g one(1)acre that immediately surrounds that soudae is used to produce income,describe the use and portion
of the property utilized to p'odure'vua-ie.
A 0 2 0 0 -- ao ?. io (o - o a y
PROPERTYOWNEDEL'SEWHEREBVCLAIMANT' ... . .
Sate,convey,and Township Is claimant vacatng a homestead?
' ❑ Yes ❑ No
of davnam n
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I hereby certify the above statements are true,correct and complete. / v ,//.fir„cO
Address of contact(number and street atm state,and ZIP code) Address of vacated homestead,(dJanyy(number and street,01%state,and ZIP cede)
7oSZ0 S� — E v .. . v `►��P3
.- "ASSESSOR USE ONLY 1 ASSESSED VALUE, , I HOMESTEAD VALUE', 17.."NON RESIDENTIAL '
Land not exceeding one(1)acre immediately .-n-t. �surrounding residential improvements I(1) -ii - - =25
Other land 1(2)
Total land(line 1 plus line 2) 1(3) _ - _ — — -
Residential improvements or - Dwelling I(4) nt iT 4 Si a t_i t`,
Annually Assessed Mobile I
Manufactured Home Garage -s F ^�"a `
Other improvement I(6) I '';77-11 °T Y"v
Toed improvements(line 4 through line 6) IF)
Total value (line 3 phs line 7) (6)
I hereby certify the above is true,correct, Signature of pssessor Date signed(month,day,yea')
and complete.
Vadyvg action-Signature of-rdiar ' a i ned(month de yea
Ii
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, -'—'-`-`r�-?J�” a_= -E= STANDARD DEDUCTIONAL'LOWANCE - " �•a-.-J..4 =Q•123iii;P"r,L7_ S:3
20 pay 20 Lncv.r 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 s MAR 8 2017
that is not assessed as real property or to a manufactured home that is not assessed as real properly may
not exceed one-hat(/Q)of the assessed value of the mobile home or manufactured home /�
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Signature of Auditor _ s Date iQt ( eh
GIESON COUNTY AUDITOF
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DISTRIBUTION:Original-CounCounty Aud:.a,Fee-Stamped Copy-Taxpayer