Homestead_Coleman (2) - .-wm
,. _ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
'( e Sea Form 5473(R17/1-16) HC70
tk`f✓l Rescibed by tit Detail of tonal Government Francs
INSTRUCTIONS See reverse sire for Ring suNxbpy.
NOTE Telephone,Social Seaai*driver'license,state ie:We:aeon and federal l0enbfica5on numbers are confidential under IC 6-1.1-12-37.
. I OW) a certify that I(we)occupied as my(our)principal 1,
place of residence or am(are)buying the following described real properly under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): On N.-
❑ Own. ❑ Am(are)buying under recorded contract. C-
❑ Am(are) entitled to wavy as a tenant-stockholder of a cooperative housing corporation. ".9 28
❑ Have a beneficial interest In the trust or the right to occupy the property under the terms of a qualified personal ,-,-.6..._“Ai- e0J,
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. 0
Casty tea Tarip&Oda(nil:b.t township)
Pacelrsmbar lrMWdesobEar lathe cg ii war
Real popery ❑Annuely nssessed melee home(IC 6-1.1-7)
Vary corbel of Ise residential structure a the land na earectu ore(I)ems that arnedaay rmaraat that ssuase Is used to poles biome,desalbe ere Me and portal
olds property ila ad to prodre imam
Z /-O(a- i& 1OO 60c 750 0 / 7
--:i :?rnP,ROPERT.Y,OWNED.ELSENHERE BYTLFIAIANT :G'M-klt ': - -
S'et,Caey,at Tremtltlp Is claimant vacating a homestead?
//�//��1arY ❑ Yes ❑ No
�ieV"_
I hereby certify the above statements are tom,aarect a1d complete. Y'
Arne of oxusd(number end sheet,dy a at ZIP code) Address of eased lasnes it sly(rsmterand meet.atsta(e.axtZIP code)
lc e / E r C6 . !Auc1SeaS,u 97ts.? ��•
- HOME HOt1-RESIDENTIAL•:r:„' :ASSESSOR USE ONLY _ _ ( 455ES5ED VALUE-: 'YI HOMESTEAD JALUE<_: 'VALUE - - '�' •��
Land not exceeding one(1)sae bnmedlatsly' _ .
surrounding residential improvements -▪_..- -._.. ,2..-s
Other land J, . K
Total land(lire 1 plus line 2 (3)
Residential Improvements or Dwaing (4)
annually assessed mobile I • r manufactured home Gamper (5) nAi:..12.,--l:r1L-ASAT «n_ ..,.__.:.
Other improvements (6) gkgartrtgiti.M%
Total improvement(line 4 through line 6) (7)
Total value(Imo 3 phs 113707) (8) •
I hereby certify the above t true,correct. 5gulae of Assessor Dap dpned(rtxreh,day,Yee()
and complete.
veiling ass-Signature aAUden Sets%mad(nr.h,dry,yea)
20_pay 20_ Lesser of 60%of the assessed vane of the homestead or$45,000.
Not6thstandng any other provision,the sum of the dedxtWrs provided in IC 6-1.1-12 to a mobile home S
that IS not assessed as real property ore a manufactured home that is not assessed as real properly may
not exceed one-half(112)of the assessed value of the mobie home or manufactured hone.
yea)
[cep (naeh,day,
L�vz,c sgned• /07- • 8 -/7
DISTRIBUTION:Original Caa.yASila,I -STaped Ccpy-Taxpayer
Paget d 2
1 . •