Homestead_Weyer s- _ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
..—N---- STANDARD I SUPPLEMENTAL DEDUCTION FORM
:v State Form 5473(R15/5.14) HC10
- Prescribed by the Department of Local Government finance
INSTRUCT IONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal WentT=50n numbers are confidential under IC 6-1.1-12-37.
- n. _ a..• y.,;'‘ . - -•CERTISICATONSTAEMENT' : . _ 'r- - - '.
I(We) �n`•
1 certify that I(we)ocollpied as my(our)principal
place of residence or am(are)buying the following described r--6•perty under contract for which a Homestead Property Tax Standard
Dedlyion is hereby claimed on the date this application is sign-•, -_ (date of signature). I(We):
Own. ❑ No(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 qualified personal residence trust .
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
Ibuymgmmnaa,Fee Simple owner's name
Recorders o6Ce,here carted is recorded • F 1L 1P
'_+.` "-"3 .r."�u1,-s'i x".•74.,, .a 4GROPERTYDESORurnoN- sic „,..,gkg '——}` =y+n
Lamy
'lamella Taxing datid(city,town,tovaish:p) 1 •• •
Parcel number Legal desa:lwm Is the property in question[
❑Real property /� ❑ An f� (IC T6-I hl--7)
d any portion of the residential atuc^.ce or the land not exceedig one(1)acre that irrmed'tety surrounds that try:tuns is us �Y tifidi.e I Al)P4 O
of the property talzed to produce borne.
rne.
021- /333-3o0- 000Q70 -W
Sate.County,and Township Is claimant vacating a homestead?
. ' 0 Yes 0 No
Sig,da:e of davnare
I hereby certify the above statements are true,correct,and complete. J> a "/ fr /,./�/'' -
&trm of contact(raanber ard.Gret,d%.Gate,and LP codee))I/ 476 y9 d vacated Mmeead,d say(number end street Wraa,and ZIP coda)
♦ _ 11 1 0 _ _'l_ I Ise 4./ I i
f•_. ~ 'ASSESSOR USE ONLY I • ASSESSED VALUE I HOMESTEAD VALUE . - I', :,•NON VESISIDENTIAL ' ..
Land not exceeding one(1)acre Immediately (1) • _- -
surrounding residential improvements
:'fT
Other land (2) __ .. .•_._._.._ .�
Total land(line 1 plus line 2) (3) I.n
Residential Assessed Mobil or Dwell-mg (4) - s _
Annually MObgel I _ _J—_
Manufactured Home Garage (5) ;ct':.•
S�=
Other improvements (6) v '- _ _
Total improvements(line 4 through line 6) (7) '
Total value (line 3 pits line 7) I(8)
I hereby certify the above is true,correct. Signalise of Asswcrpr Data signed(month,day.Year)
and complete.
Vergyig adorn-Signature of FUd or Data signed(ninth,day.Year)
at `T="-'.- a L rr CzrraSTANDARDDEDUCTION'ALLOWANCE& .4 " '.. rs-°r-cta ^'=7
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwith5anding 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 reel property may
not exceed one-half(1R)of the assessed value of the mobile home or manufactured home.
Signature of Aid.-tor Date signed(monet day,Year)
DISTRIBUTION:Original•County Audbr,Fee-Sauteed Copy-Tagayer