Homestead_Stephens 4,-1,f4-,. i CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
.-.' STANDARD/SUPPLEMENTAL DEDUCTION FORM
Stare Form 5473(R15/Su) HC10
Prescribed by the Deparment of Local Govenurnt Finance
INSTRUCTIONS:See reverse side for tiling instructions
NOTE:Telephone,Social Securiy,drivels license,state identification and federal identification numbers am confidential under IC 6-1.1-12-37.
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I(We) Cetrel rr L l� �p� certify that I(we)occupied as my(our)prinapa
place of residence or am(are)buying the fol ng described real property under contract for which a Homestead Property Tax Stallard
Deduction is hereby claimed on the date this application is signed, I (date of signature). I(We):.4k
❑ Own. ❑ Pm(are)buying under recorded contract (1 ' 1%jOl, a
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. so,1� J
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal t 4 a .- - .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. 00 elit..
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tl[vying on ewer-act.Fee Simple nears name I
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Reds Da where contract is recorded
oxer ce a
Record number Page
-ti -105 se PROPERTY;DESCRIP710th*y l3av-Vtr i= fEE- ->e is. 3
Carty Township 6Sbv7(thyt loth,twrtshy)
���st
Pared Psnber Legal tleCsvip.on �T I Is}tl�e�pyoperty in gtes5ort
Pf' Y cc!tl r-y-tn ne a./veal Popery ❑ Annualiy assessed mobile home(IC 6-1.1-7)
tl any porJoi of the resideral==re or the land rot exceecrm one(1)ace that 4nTadtsm srr unds that tauten is used to produce Income,describe the use and pwtcn
of the Popery--aired to produce income.
6- 3 -o8- Joe- alp R96oilu
- '.PROPERTY OWNED ECBEWHERE BY CLAIMANT .)•-
State,catty,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
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8lgature of tlaima
I hereby certify the above statements are true,correct,and complete. I
Address of cotat(nutter end street nay,gads,end ZIP code) Address W estead- any ' mbar and saee4 coy,side,end ZIP cede)
. c U /(.0 • r V.• '/r1 -1
ASSESSOR USE ONLY _ - r I. - ASSESSED VALUE.• HOMESTEAD VALUE;i I;:' NON-RESL1UENTIAL
Land not exceeding one ID acre immediately (1) l';',:-.1_, qtr.",.; !
surrounding residential Improvements ---...-
Other land (2)
Total land(line l plus line 2) (3) _ I - - . .. —— _
�'.
Residential improvements or Dwelling (4) I Annually cturedssed Mobile/
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Manufactured Home Garage (5) I S r `' (
Other improvements (6) --_
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
I hereby certify the above is true,correct Signature of Assessor Date alined(money day,year)
and complete.
Vmy6g aeon-Sgnabire of ksttor Date signed(month,day.year)
h - L =y-%' E?STANDARD DEDUCTIONALLOWANCErs '�-x,7`-= -�- -
20 pay 20 Lecser of 60%of the assessed value of the homestead or 545,000
Nofwithaanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
that is not assessed as real property 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 or manufactured home.
Sgne:tyre OfAuciXor [ C-J/1 Dab signed(rnn3A day.leaf)
�c5AA.-o22.< �.Z4 —/— /7
D1sTRIBIRioN:(signal-CartyAndfor,Fie-Samped Copy-Taxpayer