Homestead_Ortiz (2) 7 -- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R15/5-14) HC10
Prescribed by the Depanme t of Local Government Finance
INSTRUCT IONS:See reverse side for filing insflcWns -
NOTE:Telephone,Soda/Security,driver's License,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
' Iiij CERTIUFICATION STATEMEM?1<;; _ _- ;.'"--1-,,---;::: ,
I(We) , a ( certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real propel/ nder contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ 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 property under the terms of a qualified personal residence trust .
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
If buying on contact.Fee Semple owner's name
' 14 1114*1(Rederse5ce where conaaahm
recorded
Recorder's RV JVs • COU ItAUDITSR
ia-B" iMi_MmiEL+te=3 saaoeERn.o loixirn ir nITTE
_r7M
Cowy Township Tadng dais(city,town,townstS)
Parcel number Legal deeoirice Is the property in ques5orc
I
❑Real popery ❑Annually assessed noble borne(/C 6-r.1-7)
It any portion of the residential s titre or the land not esceedrg we(1)acre that immediately surrounds that structure is used to produce income.deseie the use and portion
of the property v3¢ed to educe vwaoe.
— l a -D 2 - X 3•DO I-(:/s•3a-f a
Seta,Carey,and Township Is claimant va ng a homestead?
. ' ❑ Yes ❑ No
of claim
I hereby certify the above statements are true,correct,and complete. •
Actress of cen'aa(number- . --, ryy,SCa,and ZIP code) ' of r—.d ,if any(number and tae(ray.sate,end ZIP code)
ASSESSOR USE OR Y v'ASSESSED VALUE' HOMESTEAD VALUE NON-RESIDENTIAL
�'. _� I �.. VAUE. .i
--Land not exceeding one(1)acre Immedlately -,--7 -777.7-5.7777-
surrounding residential Improvements (1) s-n:i_. 1..±-,CL-7.:...:.,".
Other land (2) ._..._ :.
Total land(fine 1 plus fine 2) (3) - - — —_ ..
Residential Improvements or Dwelling (4) . - -
Annually Assessed Mobile/ `-
Manufactured Home i`T'•
Garage I
(5) e i
Other Improvements (6) v
Total improvements(line 4 through line a) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above Is true,correct. Signature of A.v.wr Date signed(month,day,year)
and complete.
Veiyag action-Signature of Audio( Date signed(month,day,year)
F f_ aTrife"tMis. STANDARD DEDUCTIONAldOWANCEr '-y .— r '
20 pay 20 Lesser of 60%of the assessed value 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 $
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) the assessed value of the bile home or manufactured home.
5"vjna]ae dAddw • Pk/ Dale vs (/G yew)7
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DISTRIBUTION:Origial-Casey Audsr,Fie-Stamped Copy-Taxpayer