Homestead_Chavis (5)' CLAIM FOR HOMESTEAD PROPERTY TAX FORM r�a'F
; �� STANDARD I SUPPLEMENTAL DEDUCTION
Sa:eiorm54J3(R15/St<) HC70 ��
�" Preunbed tr� Ux Depar ent al loral Govemnient Fuanre
INSTRUCTIONS: See leverse sitle Po�filirg instrucfbns. �
NOTE: Telephone, Sotla/ Secunty, d�iver's license, slate iCenfuSCalion aiW fede2l idenGt�cafion numbers are mnfitlenlial mMer IC 61.1-f2-37. !
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Name o1 dain
Soaal Sear
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I It dmn on a
' - - " ceniry that I(we) oaupietl as my (our) prindoa
sidence or am (are) buying the following descnbed rea operty under conuact for which a Homestead Pmpe ax $tan n
is hereby daimed on the date this applica;ion is sign , (date ol signatun T , �
❑ Am (are) buying under recorded convaa. V'18SON COUNTY
e) enlitled to occupy as a tenan.-s;ockholder of a cooperative housing wrporation. '
i benefidal in,erest in Ne Wst or ihe right ro occupy Ne property under Ne terms of a qualified personal residence wst.
e) the shareholder, partner, or member of ihe entity that o�ms the property. �
ct tlaimaN (1att.S�e
name
o5m wiere mmaa is recoNea
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Parrelnun0ef L al � p¢�y Q
Pb� /� I UIQ 0 N YQ
/ . � '/� ^ /��FEeal propeM1y
XLI� ��( ti
11 a � m of Vre resitlemial s]ucure or Ne IanE not eimeEVg me ( Ju: iruxEa:4 wr Ms it�at suuaun e
d rty vaaeE m yatluce Nwme
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❑ Mmp1y assessN moNe Iwrc (IC b1.i-n
m P'�um itKnne. aesmx tne we arq oation
Is da'unant vaca5ng a hwnesteaC?
❑ Yes � No
I hereby certify Ne above sta:ements are We, cortec[, a(M comple:e.
�mie.ss m mr.ae lnumee. e�d sreer. �y. uae. e�ena wdel =
I� c� <�F rn � v.1l� 2�f �r �i2 t r.Y_�E-ro �
Lantl not ezceetling one (i) acre immetllatey
surtounEiny residenUal improvemenb
Otherlantl
Tohl lantl pina 1 plus line 4)
Residential improvam¢nts or Dwelling
Annualty Assassatl MoOile I
Manuhch�mCHOma Gange
ONer improvemenb
Todl Improvements (line d thmugh line 6)
Toplvalue (line3plisline7)
I hereEy certify Na above is we, cortect,
anE complete.
leEyi�g aoian - Sgna•.we o(Ndi�w
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20 _ pay 20 _ Lesser o( 60% of �he assessetl v�ue at :he �anes:ead w 545,000
NaM1ViN9aMmganyoNerpmvision,NesumolNetletlucfionsprovidedinlCGl.f-f2toartroMiehoma 5
Naf is not assessed as real pmperty w ro e manulacluratl lrome Nat is iwf assessed as 2a1 pmpeM may
rpt exreed one-haH(1R) o( fhe assessetl vaNe ot [he moDile hane w manulacfuretl home.
WSTFIBUTION: Oep+ul - Court:y AuE::w. (ieS`ampeE Copy - Tazp�ytt
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