Homestead_Lane (2) "a^ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
% .1. STANDARD/SUPPLEMENTAL DEDUCTION Se FORM
"tilt State Form 5473(R1515-14) ` ar�C10 I( I(p
r• Presciled by the Department of Local Government Finance V! `E
INSTRUCTIONS:See reverse side for Kling instructions_
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers am confidential under IC 61.1-12-37.
�'' CERTIFICATION STATEMENT ' -T--"T
'® I(We [ u...� ii71_I _. certify that I(we)'• • pi!. a..my o i :'n•0)
place of residence or am(are)buyi .the following described real property under contract for which a He l st--•.• •' ;x-6m err
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): C l
❑ Own. ❑ Am(are)buying under recorded contract. MAR 2 3 2015
❑ 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 e- -nal resi•-nce st.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. //s_1,,r1A1�1
' . - . - ;
If a+YiWg on aucrad,Fee Simple owner's name
Recorder's oath where ratac S remded Record number Page
's F ';:z > -- _ S _ `.PROPERTY DESCRIPTION ss ?"--_.c_ _> __,-Y S: - -'"
Courry Township town,
Taring distict
Cony to ship)
-t- G
Parcel number Legal desoir Is the property in question: r
1- rn H El I Real property [ ,Annually assessed noble home(IC 6-1.1-7)
-----If any perdon of the residential srinure or lexceecig one(1)am hat immediately surrounds that structure is used to produce income,describe the use and portion
® of the property utilized to produce income.
076-/9-/9-/e3 7e / 37Vo(Rb
Sate,Cowry,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
I'SgnavZf claimant ,,,//////
I hereby certify the above statements are true,correct,and complete. Al , C /
/Address of contact(number end street lay rate,and ZIP code) '\I Address of vacated norestead.Q any n mberend street ay,state,and ZIPmde)
�.[/\ , I T
FF. . .e It:
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3) -■'
Residential Improvements or Dwelling (4)
`y-
Annually Assessed Mobile/ i
Manufactured Home Garage (5) �s
4
Other improvements (6) fA- 0
Total improvements(line 0 through line 6) (7) F_
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Sgna;u• - Date signed(month,day year)
and complete.
Ve'dyvg action-Signature of Audtor Date signed(month,day.year)
__. l:-1-a "1-2' _ 1-, STANDARD DEDUCTION ALLOWANCE °' vrl;= -. .-. rTo, ..t--
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
® Notwithstanding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home 5
that is not assessed as real property or to a manufactured home Nat is not assessed as real property may
not exceed one-half(12)at the assessed value of the mobile home ormanufadured borne.
Sgnnaahre/ofi AuSto�r Date signed(n:0A day,year)
/�W L['Jf-4-C.;• lei
DISTRIBUTION: Original-County Auddor,File-Samped Copy-Taxpayer