Homestead_Glomski •
(Vt.", _ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
w "' STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R15/5.14) HC10
Prescribed by the Department of Local Govemmem Finance
INSTRUCTIONS:See reverse side for filing instnrctions. •
NOTE:Telephone,Soda/Security,drivels license,slate identification and federal identification numbers are confidential under IC 6-1.1-12-37.
_-• _" ' _' -.^ •. _ .'CERTIFICATIONSTATEMENT-'. _ r• i. _
I(We) U ' !2 !:1'Gl1, - -� Wo - •Pill J ' . certify that I(we) ...,1' s Y(ou••`.. ci1
place of residence or am(are), 'no the following described real property under contract for which a Horn d op 1
Deduction is hereby daimed on the date this application is signed, (date sig �.
❑ Own. ❑ Am(are)buying under recorded contract .
APR 1 S 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 qualified personal residence trust .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. I
4-,rl—
,-. '.
II buying m cataract.Fee Simple owners name
Recorder's ofice where ma-act is recorded • 'Record number Page
:a.. ±: 2".'r.- -}4.£'.`rMi tItaT{)k .FT2::ST:.-g:':PROPERTY;DESCRIP.TION'tt : ' ,'z +.:_':1'�i-- s•C' -
County Township Tang dXdd(tN.town township)
Parcel number Legal desaiptm 1 Is the Pepetty in evestO c
❑Real property ❑Annually assessed cootie tome(IC 6-1.1-7)
El any perticn ate resiferral s.-.Cae or the land not exceeding me(1)acre that i m-edately naramds that WMe is used to Poduce income.descibe the use and pardon
of the property wind to a'odu¢income.
9 - la-O6- 3o0 -000 • 1140- a,
- _ PROPERTY OWNED ELSEWHERE BY CLAIMANT ' _ _ _ .
SSa,County,and Township Is claimant vacating a homestead?
. ❑ ❑ No
5iga:ure d• (
I hereby certify the above statements are true,correct,and complete. , .
Addess of cutact(number and covet,rdy,Sae,end ZIP Cade) dr_ ;/ -ad tanevad,d arty(number and strpa,rdy,Sat,end ZIP code)
. 9/2 E7rocird
ASSESSOR USE ONLY I ASSESSED VALUE . I HOMESTEAD VALUE I , NON VALDEM
NL
Land not exceeding one(1)acre immediately — -r- '� -
surroundingresidenttalImprovements (1)
Other land (2)
Total land(line l plus line 2) (3) _ _ - _______ -.
Residential improvement or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) _ •1'(' m' 5�r•
Other Improvements (6) --4 4 ._. '
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) I
I hereby certify the above is true,correct,
Sgratae ofA•^K•c Date signed(month.days year)
and complete.
Verdy'i g action-Signet re of Auditor Date signed(north,day,year)
e -i% -y$WggE ,-AT' sr=LtSTANDARD DEDUCTION'ALLOWANCE-,'�` t%•s-..— '- - r5t7_Lr,.
20 pay 20 Lesser of 60%of the assessed vsue 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 $
that is not assessed as real property or to a manufactured home that is not assessed as real properly may
not erce e-half of the value of the mobile home or manufactured home.
Signmae or Date signed(month day,
2 Lisp
DISTRI UflON: Onghal County Audar,Fie Samped Copy•Taa ever