HomeMy WebLinkAboutHomestead_Lewis (11) ,a, _ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
"-- STANDARD/SUPPLEMENTAL DEDUCTION FORM •
- at State Form 5473(R15I 5-14) HC10
Prescribed by the Departmera of Local Dovee neat Finance
INSTRUCTIONS:See reverse side for firing instructions
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are conWenaal under IC 6-1.1-12-3,11
,-Yer . - Lc�� .i: '•CERTIFICATION STATEMENT-)r"`• L 7-c �t, `( 11 7 r
I(We)�/t C • f</f/L ! /_� . certify that I(we)occupied as my(our)principa.
place o reside '•or am trying the following described real property under contract for which a Homestead Property Ta (ldard
D uction is h-?ey clai on the date this application is signed, (date of signature). I k)(1' Z
Own. ❑ Arn(are)buying under recorded contract 011
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ��np ' •❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified peefSd& i•t--.:•�t ;;
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. OUNy. '
—��
If buying on contact Fee Simple owners name
Recorder's oBca where contract is recorded • Record number I Page
4154a) . `T r, 'PROPERTY:DESCRIPT0-!ar, •>'= /
Coo Townsip (a0;town,tam )
-. .-number Legal desaipdon Is the pent'in goes
Real pmper:y ❑Pruuaty assessed motile home(IC 5-I f-7)
e anyp�///man oftheed to stuctcm the land na ezmedzg see(1)acre that mmedvtdy swum rurw4ve¢used to poduce it me,doeibetheuseartlpmim
oftt�c
thinly V3¢ed to laoduce inc.e.
az //0?-1/Jo /w/ I - ??
•
PROPERTY OWNED ELSEWHERE BY CLAIMANT t
•
Sax.Carey.and Tr/wrist Is claimant vacating a homestead?
. - ❑ Yes ❑ No
Se,fj tlaurars
I hereby certify the above statements are true,correct,and complete. ••CC///•rill
Address of mrac(number and=eer,sy:&We,and ZIP code) a 4 if any(number and Kneel,rdy.state,and ZIP code)
L�5•ea+,
ZOO? S.vilt.vet 54-. ?rietccic 1,al 470 70
ASSESSOR USE ONLY r ' I . ASSESSED VALUE I HOMESTEAD VALUE- _ NONRESISIUENTWL
Land not exceeding one(1)acre Immediately
surrounding residential Improvements (1) 2._s .=_t--, n _:,._1 1',
Other land (2) (�„ _...-._iu zit
Total land(line 1 plus line Z) (3) - - - — ._
Residential improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5) s` y
Other Improvements (6) ---:, _ ---
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) I(5)
I hereby certify the above is true,correct, I Sgna:ue of Aesessa Dab signed(ngnth,day.yaw)
and complete.
Verifying aeon-Signature of Rodior Date signed(morn,day.year)
'!' ,.._�_ � :,=. STANDARD DEDUCTION ALLOWANCE {`�3¢ta
20 pay 20 Lecsrr of 60%of the assessed value of the homestead or$45,000
Nor ilhsanding any other provision,the sum of the deductions provided in IC 6.1.1-12 to a mobile home S
that is not assessed as real pmpe y or to a manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home ormanufarlured home.
Signature of Padaor Date signed(moth,day,yea)
DISTRIBUTION:Original-Canty Auddor,Fie-Stamped Copy-Taxpayer