Homestead_Powers (5) FILED
^v CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
1 NOV 2 6 2018 FORM
State Fonn 5473(R17/1-16) HCt 0
,�� Prescribed by the Department of Local Government Finance )049.
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and fedeedelE AdatT i gj1Mg45 NejgreeRial under IC 6-1.1-12-37.
// /� CERTIFICATION/
I(We) //,12 p/slyy -1 + 7Pri' L 4 k)etc certify that I(we)occupied as my(our)principal
place of residence/6r am(are)buying the following described real property 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):
❑✓ 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.
It buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing dr cl own,township
Parcel number Legal description Is the property in question:
[Real property ❑ Annually assessed mobile home(IC 61.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
;?6-/3-z3- is -
-ooQ /DSS l�
(r0351;iiii1V OWNED 02 t1CR aT•
State,County.and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Kite-
Address of contact(number and street,oily,state,a ZIP code), Address of vacet d,if a number and street,My,state,and ZIP code)
/9a() ._50 . - t-/(i (7 3/ 74, 60
ASSESSORaar ASSESSEDMM HOMESTEAD VALUE NON-RESIDENTIAL
V•T
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements I(6)
