Homestead_Hooker CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-t_^+ ? STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(RlS/614) HC70
• Presaibed by the Deparrent of Local Govem:tent Finance
INSTRUCTIONS:See reverse side for Thi ng instructions.
NOTE:Telephone,Social Seasrity,driver's license,state identification and federal identification numbers.1- ei ;.'nU.1 under •.1-1�`,
--
t;
ce that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Hon steaddj�{{QQppe�rty Tax Standard
Deduction is hereby claimed on the date this application is signed, FF Rae of s4 1JAT7e). 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 ps Qapfgtrust
❑ Am(are)the shareholder, partner, or member of the entity that owns the propert 18 SON COUNTY A u.1 UR
- --_ _� -.. ?»CLAIMANT'S INFORMATION>_ " t- .' —.. __. .
If buying on contract Fee Simple owners name y
Recorders office where centred is recorded Record number 1 Page
r .__._ -%'-__-. '- L4. -=-a _.;PROPERTY_PROPERTY-DESCRIPTION yt -1_r�. ,L-1.v 4ti-rils
Cam Township Taxig district(ply town,township)
$4 A� 1- em_ci ion:
P mumbx l Legal dJes�cription Is the property a question_
,a�_'V -13-qO a 000. 116-0 C Real propery ❑ Annually assessed mobile home(IC 61.1-7)
If any potion of the residential structure ar the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the properly utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
7
Signature ofd . art
I hereby certify the above statements are true,correct,and complete. `/1!J (/%//
AGWess of oantacc umber and greet albsreta.and BR cede) Address of vacated homestead,d any number and street,arty gate,and ZIP code)
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
Other land (2)
Total land(line I plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total Improvements(line 4 through line 6) (1)
Total value (line 3 plus line 7) (8) IgI
I hereby certify the above is true,correct, Signature oftasessa p si_ day.Year)
and complete. g
Vetting action-Spann ci Aslant Date signed(aorta day,year)
FEB 5 2015
-tic .t^ .___ a: - Lr {'_J STANDARD DEDUCTION ALLOWANCE3a•'t c�-'-�'^ s-%3 �"`�„t'S.S'`.-��':::_
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000 `/L///J/��t/�!p�A�L(,�(,J%V tIM}('
Notwithstanding any other provision.the sum of the deductions provided in IC 6-1.1-12 to a mobile�ho,m�e�t�s,� S_ l w'lr AUDITOR
that is not assessed as real property or to a manufactured home that is not assessed as real pry t�V
not exceed one-half(1R)of the assessed value of the mobile home or manufactured home.
Signe" d dear • Date signed(month day.year)
/ \ L yYv�l t L a o a.- c-is
DISTRIBUTION:Original-Canty Nd.ar,ReSamped Copy-Taxpayer
�`-'��`4 CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
� a
i Siate Fortn 5473 (R2 / S92)
'�:%(,
INSTRUCTIONS: See reverse side !or /iling instructions.
FORM
HC10
YEAR
� CE FIC ON STATEMEM
I(VJe) - Ai tHat on + day of March, 79_
I(We) occupied as our principal place of residence the following described real propeAy for which a Home��tg� P�op�rtyr7@A Credit is hereby claimed:
i•w�C J LUU��
❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taues on ihe property and th wns the pro e r is buy' g u er a contract.
�, i .
� CONTRACT RECORDED D V i^•�.^..l, �':,Jt�7Y 4li�IT �
If buying on conVaa. Fee Simple owners name
Recardefs ot(�ce where conUact is recordeC - Record number Page
PROPERTY DESCRIPTION
n Township ' Ta�ting district (dty, fown, f hip
arcel number � � Legal description
I
II any portion of Ne residential s[ructure or Ihe land not exceeA�ng one (1) acre that i iatety surtounds ihat swcW re is usetl to protluce incwne, tlescribe the use arW poNon oi
Ne D�operty uulized ta produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
" nature imant
�areby certify the above statements are true, correct and complete.
Atldress (number ar�d streef, aty, sfafe. ZIP cotle) �
�lCv�2Ch </�S
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VAIUE
Land not exceeding t(one) acre immediately (�)
surrounding residential improvemenis. -
Otherland � (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5) -
Other improvements (6)
Total improvements (line 4 thiougA line 6) (7)
Total value (line 3 pfus line 7) (8)
I hereby Certify the above is Irue, COrreCt, and Sgnature ot Assesor Date signcd
complete.
Venlying action - Signature of Audimr Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S �
Valuation or S2.000
t e of Au or Date sign
_ �3._�