Homestead_Motter CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r,. STANDARD/SUPPLEMENTAL DEDUCTION FORM �
Slate L�Jte Fa 5473(R17/1_16) HC10 0 k et
Pre:need 4me
the
Depet er Loral Gwartm For
ce rme
INSTRUCTIONS:See femme side for(Erg instructions.
NOTE Telephone,Soda/Security driver's Ecensa,state ifaridca%on and federalNertitica5mr numbers are confidential under IC 61.1-12-37.
TIVEI(We) • certify that 1(we)occupied as my(our)principal
place of residence or am(are)buying the following deserted real property under contact for which a Homestead Property Tax Standard
\\De/dduction is hereby claimed on the date this appfration is signed, (dale of signature). I(We):
Own. ❑ Am(are)buying under recorded mlhad.
(ale)entitled to oCanpy as a tenant-storkhoIder of a cooperative housing c rpaati
an..
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified persasal residence trust
❑ Am(are)the shareholder,partner.or member of the entity that owns the property.
N
Sams Seasity numbs or Tomas made(bm to Opts) Giver's'ocene I Iderddcatton l Otter aaneer of dements spouse gas ere derby Lssrcig 92e
W eetatie crag a apprc,fl spade des not haw a morel scatty ouster)
saw I I I ice.
e tufty mmere*Fee Simple oars name i I i !Sr
Rimers Mice Mime mares nrecorded MAR 2 6 201'Rem'd`.mber Page
- - -- - . - - _,,, ,P�R,O1PUERTY OESCRIPTIOY e- � - •
Canty Toensrdp J DTI ' 1\ . �'�(N T�&iLTlTe or�i
I INTY AUDITOR
Pratt„ CIBSON� b
�0 Rea rrx e1y 0 Armed&messed molls t®(IC 61.1-F)
It cry paeaf a the resea s rmmte or fie lad not mambo me(I)acre OM immediately samads that singe Is used to flue bcome,describe the use aid portico
of fie Propmb u6[zed b pram Somme.
Co.t—» re IZ 201 -t- 0- I VI g -022 .
- - - _ -PROPERTYOWNED ELSEWHERE 9Y CLAIMANT - _. .. - i
Stare•Canty.and Township Is claimant ' a homestead?
Yes No '
I hereby certify the above statements are true,correct,and complete. "4/
A. isey
�tf
Address a ante(number-• _-- r<y,aftt,and ZIP \ Address _or - .,-.tax n:et,amy(nuttra st
et,cey,.tea,and ZIPpmb)
W . "NIim - tvole Jn
l?. ASSESSOR USE ONLY - I. ASSESSED VALUE-' HOMESTEAD VALUE -:- •NON"RVEUSIUENTIAL •. .:
Lend not exceeding one(1)acre immediately - es t, -i=
surrounding residential improvements (1) . L ; s&.s t 7.-;-,
Other land - rL
Total land pine I plus tine 2) (3)
hnprovema 4 -.t g y ','S.:-
ReResident'snts or Dwell)rp (4) "' x v `'g
annually assessed mobile I - v t
manufactured home Garage (5)
Other Improvements (6) 3 s c_... a Z± i
Total improvements pie 4 through line 6) (7)
Total value gie3 phis line 7) (a)
I hereby certify the above is tree,correct, Wears 01Maeam Dasib(mothday,yam)
and compete.
*raying swn-Siasmae aiedix On died(tunas day,lea)
�� '" I - --• . ' 'STAUDARD DEDUCDON ALLOWANCE - -. �.20 pay 20 Lesser of 60%of the assessed vane of the homestead or$45.000. .
Notwithstancfrg any olherpmvisias,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 manufacfred home Mans not assessed as real pwpady may
not exaeeedl one-hall(1/2)&th�e/ass�sesseeddd value of the mobile home or marutachaad home.
Sip
Ala(" Y_ _ `]v'\1 • _ Datesimad�UrmlYlsccol;yew)
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DISIW3U110N:Odgua-Casey Audtor.Fie-Stamped Copy-Taxpayer
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