Homestead_Mahinay CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
7,�; STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R1515-14)
�` Prescribed by the Depa-tneNof l al Government Finance
INSTRUCTIONS:See reverse side for fang inshuoims •
NOTE:Telephone C•c'al Security,drivers license,state identification and federal identification numbers am Gonad: : 'g • .1-1 -
'-- - : - IV"_ - f'c TIFICA]ION STATEMENT.•' : '.•1 D {t a1 I. °-(LE-1 f'1 Nr
I(We) I��1'i� � ' f. a - certify that) .-)o) ••-• 1.: • •_ •
place of residence or am(are)buy••+t the following•e • •>•real property u 4 r contract for which a Homestead Property Tax Standard
Deduction is hereby daimed on the date this application I signed, (datAA; uff)pl00 Y :
❑ Own. ❑ Am(are)buying under recorded contract
❑ 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 qualifi rso - ce trust .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
If buyig on contact,Fee Simple owmfs name
I Reader's o5ce where contract recorded Read nienber Page
•
Yom' giez. fi•°.f.-X1.15Yn_ : ;'• i. rTT 'iEROPERTY,DESCRIP.TION-ThIf:44 -41:-
GnmY
Township Taxing&strict My,town,township)
Parcel number Legal desaiptnn Is the property in question
❑Real Facer:). ❑Amway assessed cootie lame(IC 6-1.1-])
U any portion of the resiaxal=dr-re-or the land not;mesa;one(I)acre that bn edret1 omrasds that sTC x a used to produce 4core,describe the use and perim
of the property ttlaed to produce iwwne.
-a3 -0I • aoo - do s. aG �-oay
Sate,County,and Township Is claimant vacatng a homestead?
. ❑ Yes ❑ No
Signature of
I hereby certify the above statements are true,correct,and complete. -
Ad:tress of run'd(number end 5reey city,G&e,and LP Cade) / coated ,if arty. end Crest street r ty,Ga.e,and ZIP Code)
/r50 i (a LJEr1 aci 3
- ',ASSESSED . NON-RESIDENTIAL
��ASSESSOR USE ONLY i. VALUE .I HOMESTEAD VALUE 111' .VALUE
Land not exceeding one(1)acre Immediately I(1)
surrounding residential improvements = _
-_Other land I(2) _ �.� . z
Total land(line I plus line 2) (3) - - _ _ -
Residential Improvements or Dwelling (4)
Annually AsseH Mobile I
Manufactured Home Garage I(5)
Other Improvements (6) r'L
Total improvements(line 4 through line 6) (1)
Total value (line 3 plus line T) I(8) I __
I hereby certify the above is true,correct. Signature of Assessor Date signed(month,day,year)
and complete.
Ve dyig adorn-Signature of Adam Date signed(month,day.year)
_iEigite y3;s'f ,:raTa t-TOSTANDARD'IDEDUCTION'ALLOWANCE'? T a, -t=1:ssJ- -_ s-7`
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notwirhsandng 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 properly or to a manufactured home that is not assessed as real property may
not exceed half(12)of the assessed vat of the mobile home or manufactured home.
Signature d -s� Der signed(math,day,year)
DISTRIBUTION:Original-Gainey A da,Fie-Stamped Copy-Taxpayer