Homestead_Clevenger -
.. CLAIM FOR HOMESTEAD PROPERTY TAX r YEAR
r-t STANDARD I SUPPLEMENTAL DEDUCTION FORM
RU
5.
Stay Form 5473(81515-14)
Prsaibed by the Ogznmert of Loral Government Finance
INSTRUCTIONS:See reverse side for Tang instructions
NOTE:Telephone,Sofia/Security,drivers license,stale identification and federal identification numbers are confidential under IC 6-1.1-12-37.
_ .- ;CERTIFICA'.IONSTATEMENT'a,7• :s. . — -tor':_ -r-=.
I(We) OI�/ // + �_ a .' .I rt � certify that I(we)occupy as my(our)principal.
place of residence orAm(are)buying the following d;,--bed real property under contract for which a Homestead o Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of si I ):
Own. ❑ Am(are)buying under recorded contad.
❑ 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 pers,Onsidence tru
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. I 1 2 8
son '., :.,,'
1 If[vying on miYact Fee Sink owners name
1 Reorders pace where contact a recorded • Record number Pape
Aar.tor. .,.'___
. Cwvdy Y 6 eari-i1PROPERTY DESCRIPTION wa LY ex 4- . ,0 'rwY -. a '--*",:'..0.3
Township
i.i. .._ _'7tm�vr4Q�v/,�s
LU[ir 4
Parcel number Legal desaiaon Is the progeny n pues'von
1 �`]�rnryC,L,��eal
popery ❑Annually assessed noble home(IC 6-1.1-7)
d any poison of the residceal cuare or the land not except-9 one(1)acre that':-chasm sinmds that et-Inure is used to;educe income,descibe the use and erica
of the;Party Lt ed to produce bourne.
- 6—//— /6- 3 6-0 coo 6:59 oa 7
_ PROPERTY OWNED ELSEWHERE BY CLAIMANT _ • - • ,
Stan.Curry,and Township (Is claimant vacating a homestead?
❑ Yes El No
. Sir e of daimara
I hereby certify the above statements are true,correct,and complete. ..S1N-1 A � ��.o
Address d coma(number end sheet ody,date end ZIP ode) cs^C' n Address of vacated hen yd`,d any(number and apse(city,state,and ZIP code)
>' )b S % , -S 1.0 . el
ASSESSOR USE ONLY ASSESSED VALUE 'HOMESTEAD VALUE .NON-RESIDENTIAL? -
_ I. I I.:' VALUE
Land not exceeding one(1)acre immediately '° !tr.:.-4..;,Ter.:,."7.,; .
surrounding residential Improvements (1) 'z..; _.15 ,"_: .. .
I __ _ _ _
Other land (2)
Total land(line 1 plus line 2) (3) _ _ I _ __ _
Residential improvements or Dwelling (4)
Annually Assessed MObilel
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (6)
I hereby certify the above is true,correct, Signature of A -r Date signed(rm:h,day,year)
and complete.
Vedyi g edicts-Signature of Md:tor Dabs signed(merge.day,year)
5.-- •-.P-ve .. - t-'`-- dBTANDARD DEOUCTON'A4LOWANCE
20 pay 20 Lesser of 60%of the assessed value 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 S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-hat(I/2)of the assessed value of the mobie home or manufactured home.
Sera^se of A d':tor 101--) Date sig:ed(month.day.year)
.717
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DISTRIBUTION: Orgial•Gouty Auftce.Fie-Sarnoed Copy-Tagayer