Homestead_Reed (2) f'�
• CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
" -. STANDARD ARD I SUPPLEMENTAL DEDUCTION FORM
4 State Form 5473(R15/5-14) HC10
Presorted by the Dept-anent of Local Gove_-.eft France
INSTRUCTIONS:See reverse side forfifng ins✓uctiau
NOTE Telephone,Social Security,&rivets&tense,state identification and federal identification numbers are cnffidential under IC 6-1.1-12-37.
_s:r_1.'%`r _ -- ZCERTIFICA11ONSTATELIENT'^ ^f.._. cr ir, T F.irriry_
I IWe) V �i-��I i -1 certify that I(we)occupied as my(our)pci :
place of resi•ence or am(are)buying the following described r--I property under contract for which a Homestead Property Tax Standa
Deduction is hereby claimed on the date this application is signed, (date of signature). I(W�f^�
Own. ❑ Am(are)buying under recorded contract. '^ry1 v
�Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 0/p.. ' a 10i
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified perMde 1 , -'trus .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. •CO �j i ,
'- - •
It hying on cord-act Fee Sample owner's name
Reader's&ice where contract is recorded - I Record number Page
': WnWi _ -- P.ROPERTY,DESCRIPTION `%.,.�L/"-�- - e,:r ..S
County Township I Taxing 'd lawn townVsMAip))�l
Parcel number Legal description Is the property in goes-eon:
aGEC -
E- Real property ❑ Annually eeeen motile home(IC 6-1.1-7)
It any portion of the residential smxaae a the land not exceeding one(I)acre that Nmedately suntan &that structure is used to produce income,deslbe the use and portion
of the property Wined to produce income.
a 4, -ao-i/ -ao / ono3`90 00
•
DE E I . . _ _
- t ' , _'. '�y .PROPERTY,OWNED ELSEWHERE BY CLAIMANT v' •
Sate.Carey,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
3ociairmara
I hereby certify the above statements are true,correct and complete. % q _ „/
Address of contact(ranter end street ay,Sat).and LP node) ad , d any(( and street,ary,55e,and ZIPcode)�
I, CY9GS SRs7 e- t e _ 660
• IASSESSOR USE ONLY - I. 'ASSESSED VALUE I. HOMESTEAD VALUE ' NON-RESIDENTIAL
. VALUE
Land not exceeding one(1)acre Immediately
surroundingresidentiallmprovements I(1) — -re_�x,_'_:f.`•.
Other land 1(2) -.
Total land(tine 1 plus line 2) (3) - - -_---•
Residential Improvements or DwellIng (4) w o at-arirr4. c�l°'4:t.Annually Assessed Mobile l
Manufactured Home Garage (5) cite '`4rr•s
Other improvements (6)
Total improvements(line 4 through line 6) I(7)
Total value (line 3 plus line 7) i(8) I I
I hereby certify the above Is true,correct Signature of Assessor Date signed(month,day,year)
and complete.
Verdying actin-Signature dkidtor Date signed(Mont,dday.year)
• STANDARD DEDUCTIOWALLOWANCE-° 'r,
20 /7 pay 20/ , Leseer of 60%of the assessed value of the homestead or 545.000
Notwithstanding any other provision,the sum of the deductions provided in/C6-1.1-12 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(1,7)of the assessed value of the mobile home ormanufactured home.
Sgnatn of Author Daired(mat' dayyea 7n/2 ' 1 X
DISTRISUT1ON:Orgiel-Couray Aud en,Fli eSamped Copy-Taxpayer