Homestead_Hix CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
)6 STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R17/1-16) HCIO
Rescribed by Me Department at Local Government Finance
INSTRUCTIONS:See reverse side forhtung instructions.
NOTE Telephone,Soda!Seoay drivers ksnse,state ides art andfaderalI (ambers we co,t*,tial under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
1(WE) - • . 1 De1tiN that I(we)oI%al (.I '..-
place of residence or- - -) . _es abed real property under contract tar wrtddr a .
Deduction is hereby datrned on the date this application is signed, (data of
Puna ❑ Am(are)buying under recorded contrail. MAR 1 — 2014
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the brat or the light 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. .
S
Pads minter Legal Uasoptm lathe p ,IY it question
I cue.among ❑Nnsady amassed mmobie haw(IC 6-1.1-1)
I any portion d the maternal eauclue or 5e land nee meteyg one(I)no that laredmy sumatls that structure Is used a prnnta income,describe the use and radon
dee properly mitred a perdue aeone.
a — , a _ o - coat ono - ata 6aW
__ - _ .?PROPERTY OWNED ELSEWHEREE BYC LA IMAiJ I ;:"!' 'y .�' ,_ _.., y_
Sfax,Candy,and Township Is claimant vacating a homestead? -p
El Yes • No
d..
■
I hereby certify the above stateme s are true,correct,and compete. / „ -
�•
d=dad( and- , and esa -. -:r ffi.b, ZIP=LI Adieus d-..,r�1.t
M6 (muter-We*may.ante,and ZIDmde)
,�.
- fO R E,H.I DENTIAL
:ASSESSORUSEONLY . ASSESSEOVALUE,._ HOMESTEAD VALUE "_"-.1
) immediately _
surrouncrexceeding dental improvements � q A\
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or (4)
annually assessed mobile
/
nufactured home Damage
ma
(5) ?
Other Improvements (6)
Total Improvements(line',through line 6) (7)
Total value (line 3 plus tine 7) (8)
I hereby certify the above is true,correct,
Signature dAseesn Data (Q o �>�
and complete.
Verifying Meal-Structure dAS FtedLi.i ;D
"-"` _' ' - 1 STANDARD DEDUCTION ALLOLVANOE. -- "ry
20 pay 20_ Lesser ofce%ot the azsessedram of the homestead or 545.000. MAR 1 — 2018 ...�
NMNMSlandi g any of erprosl ion,the sum of the deductions provided N IC 6-1.1-12 to a motile hale $
that is not assessed as reel property or to a manufactured home that is not assessed as real properly may
rot exceed one-ha(1/22&the assessed value of the mobile home or mamteiSaed hore a
=PILL . en 2 A.(ACJ G =acv •1 O Ulf r AUDITOR
Oa1WSUTION:Orgvel-Carty Aesgtor.Re-Salved Copy-Taxpayer
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