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Home My WebLink AboutHomestead_Holt .. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR -•'r° . STANDARD/SUPPLEMENTAL DEDUCTION tHC10State Form 5473(R15/5-14) �- Prescribed by the Department of Local Government Finance FORM INSTRUCTIONS.See reverse side for Ong tense,state • NOTE:Telephone,Social Security,driver's Sirens,state identification and federal identification numbers are confidential under IC 6-1.1-12-3 d _ . /Jr,.".•.G, - - CERTIFICATION STATEMENT- ( ' • . ,'�"' ( I-. . / % !-�i _ I(We) /.i-/_ !_i�� . certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax S(ala�ld 1 7 2017 I Deduction is hereby claimed on the date this application is signed, (date of signature). I(We: ❑ Am(are)buying under recorded contract Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ' , -7eMilif ❑ Have a beneficial interest in the trust or the right to occupy the properly under the terms of a qualified personal U TY AUDITOR ❑ Am(are)the shareholder, partner, or member of the entity that owns the property. GIBS• , If her ing on contract Fee Simple owrcts name Recorders o5e where arm a is recorded • Record number 1 Page L E--` +sMs U:Kea L`4s^!p3°. ��»;�: tiP,ROPERTY,DESCRIP-TION s..-E$- ?:, 14 %1_ Camay Township Tail;(Istria(city,tarn.township) Parcel number /al descipton Is the property in eues]on: ❑Real property ❑Annually assessed mote home(IC 6-1.1-7) It any portion of the residental sTbae or the land not exeed:g one(1)acre that immediately a rounds that esuaure is used to produce income,descie the use and portion of the property utilized to produce income. 86-19- 31-304 -0© 0. 0 yy— 009 _ - • PROPERTY OWNED ELSEWHERE BY CLAIMANT • _ State Count.and Towrstgp Is claimant vacating a homestead? . 4..._ ' (Dees D No re�of it I hereby certify the above statements are true,correct,and complete. Address of contact(member and meet of stab,and ZIP code) Address of wra:ed:ianaeead,d any(number and sties(city,stile,and ZIP cede) 3�(7 5 shah e.1n bS ��t' �n Jb . ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE• r 9 VAE L,_ • NON-RESIDENTIAU . Land not exceeding one(1)acre immediately - - .u'T `:.;r surrounding residential improvements (1) zr-.___:_:,::�&Cs ems..,_ Omer land (2) __ir :' Total land(One 1 plus line 2) (3) _ .. - ___ _- Residential Improvements or Dwelling (4) Annually Assessed Mobile/ - ---- Manufactured Home Garage (5) ^ r-% Other Improvements (6) �.nv , Total improvements(line 4 through line 6) (7) Total value (line 3 pits line 7) I(6) year) Signature hereby certify the above Is true,correct Signature of Assessor Date signed(mot day year) and complete. Verdyvg an-Signature ofAUd.tor Date signed(rnonit,day,year) z'7-3 ' tiny. -.x- — _ - >^'STANDARDDEDUCTIONALCOWANCEFrl" =:4; -'�-1 - 20 pay 20 Lesser of 60%of to assessed value of the homestead or 545,000 Notnithstandlg any other provision,the sum of the deductions provided th IC 6-1.1-12 to a mobile home $ that is not assessed as real property or to a manufactured home that is not assessed as real property may not exceed one-half(12)of the assessed value of the motile home or manufactured home. Sgnauae of Ard; Date signed Unruh,day,year) C .1fe L3-- /7-77 DISTRIBUTION:Original-Corny Aud:or,Fie-Samped Copy-Taxpayer