HomeMy WebLinkAboutHomestead_Hemmer kit, STANDARD DARD I SUPPLEMENTAL DEDUCTION FORM YEAR
d ,1, State Form 5473(R15/5-14) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state ide e-o lion and federal identification numbers are cot.5d-. w.6: I. - 1.1- -
owing described real prope under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the dat- • is application is signed, (dastafcigpalyre olp fe):
'Own. ❑ Am(are)buying under recorded contact /i RR 11 77 CC lull Il//
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
Cl Have a beneficial interest in the trust or the right to occupy the property under the terms of a q -1: M1•4J ,-nce trust
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. GIBSO I s •
_`.._
If toying on contact,Fee Simple owner's name
1 Recorder's o5ce where contract d'v reseeded Record number Page
aa°°e"'2v`�3' az,, e.,�; =it?RORERTY:DESCRIPTION-.: _s—.z'—.- . '.6+ttl.,- 's ' i "uJ Sti;)Z!
County
Township Taxing daru4( . h Iaand+sl
ory property in quested:
Parcel number Legal desaipion Is •e prope4�rty in quested:
11742 property ❑ Annual,assessed moths home(IC 6-1.1-7)
If any pot of the residential shuCCe or the land not exceedng one(1)acre that LnmedYxly- • ,..that aS ore S Lsed to produce ircame,deseibe the use and po^.mn
claw e popery offted to produce inn e.
a6—/ 3 —i 9— d 6 cR -ctc. /r o 005 A/
Win . 5
-..-, .PROPERTY OWNED ELSEWHERE BY CLAIMANT _„ -,
Sate,Corry,ad Township, Is claimant vacating a homestead?
. - ❑ Yes ❑ No
'/LEI V
I hereby certify the above statements are true,correct and complete.
Address of con•a ct(number and greet dry,date,and ZIPcode) 47641 Address of vacated homestead.4 any(number and street,sty rare.end ZIP code)
IO7 S i h-1(-ht 4O5 owl% Fr&/lct a
Land not exceeding one(1)acre Immediately
surrounding residential Improvements I(1)
Other land (2)
Total land(line 1 plus line 2) (3) _ ___ -
Residential improvements or Dwelling (4) -
Annually Assessed Mobile/ g O I e C.-' (x'
Manufactured Home Garage (5) I ••-°T—'Y _ _ _.
Other improvements (6)
Total Improvements(line 4 through line 6) (T)
Total value (line J pits line 7) 1(8)
I hereby certify the above Is true,correct, signature of A....w Date signed(month day.lead
and complete.
Velfying adion-Signature oAudtor Date signed(month,day,year)
_s"x` -. � '- "�-z'- Jr. .-2 - STANDARODEOUOTION ALLOWANCE = _ -{y` _.?
20 pay 20 Lecedr of 60%of the aesessed vdue of the homestead or 545,000
Notwi hfanding any other provision,the sum of the deductions provided in IC 6-1.1-1210 a mobile home S
that is not assessed as real popery or to a manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of thee mmobile home or manufactured hone.
Sig r \ / Date signed(mord;day,year)
DISTRIBUTION: Origgnal-Corny AUd:r,Fie-Stamped Copy-Taxpayer