Homestead_Sievers - CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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:STANDARD/SUPPLEMENTAL DEDUCTION FORM
.1 Stars Form 5473(R1515-14)
Prescribed by the Departmerd of Loral Gwenanerd Finance
INSTRUCTIONS:See reverse side for firing instructions
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
.r' ----r"7c. -- 7 • j-S .• .- . -CERTIFICATII IN STATEMENT- 1-a '_ -r"?_y - 7 -. .-_.
I(We) [!•, ?5.i•aVTI3IWW�� ' . A A certify th1 wa ..i pied ;- jww'��j,,ndpal
place of residence or am(are)buying the following j scribed real property under contract for '• a , •, /--. -: .—f- -.'-ndard'
Deduction is hereby claimed on the date this applies on is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract MAY 16 2017
❑ 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 q Iced personal r- Wen.- trust .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. , ei
_
..:
V bryf g on contract Fee Sipple owner's name
Rem:defs oece where contract is recorded - —_.I Record number I Page
W°_-''e1gTE4.�+', �'�� y ttittX a"-'a i 'P,ROPERTV7DESCRIPTION I
Dow. 1 Township Taxhg&grid(city,town To.rania)
Parcel number Legal description Is the property in Ruadiort
❑Real property ❑Annually assessed:noble lore(IC 6-1.1-7)
8 any portion of the residertal sT.lmae or the land not exceedxg cat(1)ace that inmate.*surrounds that Kncere is teed to produce imams.deso*e the use and porum
of the property'razed to produce income.
a6 - ,' -06- 300 - 6Q1 135-Dal
U •
-. - PROPERTY OWNED ELSEWHERE BY CLAIMANT - _ - ;,
y- �- 'p Is claimant vacating a homestead?
...„400, ' ❑ Yes ❑ No
Signature or china:%
I hereby-cart the above statements are true,correct,and complete.
Add-_of //``//''''��dJJ(nt)p(Oer andreet,igy :te and ZIP end.% d vacated I.., oil any(number and street,al%data,and ZIPmde) .
,' !ASSESSOR USE ONL'! '! I SSESSED VALUE ,'I t:HOMESTEAD VALUE -,
'NONRESIDENTIAL
VALUE..
Land not exceeding one(1)acre Immediately (1) - - - --
surrounding residential improvements (1)
Other land (2)
Total land(line 1 plus line 2) (3) . - - - .
Residential Improvements or Dwelling (4)
Annually Assessed Mobile l -- "-
Manufactured Home 7 rfer(5)
Other improvements (6) .. - - _..._'.t,•:
Total improvements(line 4 through line 6) (1)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct, Signature ollaa sac Date signed(month,day,year)
and complete.
Ve fytg action-SgnaWre of Author Date signed(month,day.year)
'n'4z '-_ + -' k,-Vi =��`STANDARU DEDUCTIONALLOWANCE"a.thW at, 5 ricsi+ ,y
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notnithstandmg any other provision,the s m of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not ssed as real properly ort manufactured home that is not assessed as real property may
not ex aff(/12)of the aloe of the mobile home or manufactured home.
1 Signature of • DY S (r y ye7 l
DI5TRIS1TON:Original-Ccaty AUdto,Fie-Damped Copy-Taueyer