Homestead_Sorgius r .._ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
:v jState Form 5473(R1515-14) HC10
Prescnbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for fili g instructions.
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers aro confidential under IC 6-1.1-12-31 .
_ ' - 7„}'._ " ,:,i '-- CERTIFICATIONSTATEMENT"••_. , �•• •r:—_ ' �� Z .-1•-'1
•
. I
-' I(We) • • .. D 4" 1 • /i c .. 1LS _ certify that I(we)occupied as my(our)prindpal
place of rE dence or am(are)buying the following described real property und- w•ntract for which a Homes:
Deduction hereby claimed on the date this application is signed, (date of at ). (We)
a 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 properly under the terms of a qualified persoMAy'sictn0£{?F7 .
❑ An (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contact.Fee Stemple owner's name
Recorders office where contrau is recorded • Record number Page
' lyyf-Ai"3ir:'a`�`Ot':.ffi`i P.ROPERTY:DESCRIP,TION'.r t .v%'O• F-' . -_r: __i ,-s.
Cerny. Township fa (city)own.townxNp)
I r a
Parcel number Legal desaip5on /���, /I Is the
7 pope. ❑Amualy assesses nettle home(IC 6-1.1-7)
If any portion of a edtto podureJC or the 1]M not exceedng one(1)sore that NCmCIX2ly 1R5 that SJIlC3LT C used to RCVS income.describe me•3e and portion
Of the peppery IeS6M to n'MY2 income.
aO;•-02‘3 —oa —acs .Cra Sfsa 0 L
•
• ,. - EB CLAIMANT ...
'PROPERTY OWNED ELSEWHERE BY CLAIMANT _- -..vz)_ c -
lava.County.and Township Is claimant vacetng a homestead?
. ' El Yes ❑ No
1 Sig a:we of
I hereby certify the above statements are true,correct,and complete. A,c.
Andress of cores=(number and greet ray,state,and ZIP cede) Add. ofred _rmestead.tirry(number'and Sree4OtSat,and ZIP rode)
X a6si o' d . f rf ffw S,f�/rice nu.
ASSESSOR USE ONLY. ASSESSED VALUE w HM
OESTEAD VALUE 'NON-RESIDENTIAL SIUENL
•Land not exceeding one(1)acre Immediately
surrounding residential Improvements I(1) ( • 3.x b
Other land (2) <' 'T t-4 _ .... .e,
Total land(line 1 plus line 2) (3) _- __
Resldentlal improvements or Dwelling (4) a a � 1$y N_ .
Annually Assessed Mobile! `
Manufactured Home Garage I(5) _ _ _- ''•'
L
Other improvements (6) I�'_'.'.--•' `
Total improvements(line 4 through line 6) (7) I
Total value (line 3 plus line 7) I(8)
I hereby certify the above is true,correct, I Signature of Assessor Date send(month,day,year)
and complete.
Verdyig action-Signature of AOdb Dare signed(month.day yea,)
-rAt °"J•STANDARD DEDUCTION'ALLOWANCEf `"�i.z4.6 .5.—
20 pay 20 Lesser of 60%of the assessed voue 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 mat property or to a manufactured home that is not assessed as real property may
not exceed one-half(V2)of the assessed value of the mobile home or manufactured Mme
Sglets,of .tor Date signed(moth,day,yea)
L5 1? oS A( .5-/o -/ 7
DISTRIBUTION:Original-lavyArddor,FieSamped Copy-Taxpayer