Homestead_Braun (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r' STANDARD/SUPPLEMENTAL DEDUCTION FORM
:��.. State Form 5473(R15/5-14) HC10
Prescribed by the Department of Loral Gwu�.,Ra Finance
INSTRUCTIONS:See reverse side tor filing instructions. -
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers.r. .i en i under i ' -� .
T x'; . " r`•• -''CERTIFICATION STATEMENT :•': -- `''j a v`.T, ' ` r^'•'- _ -•
I(We) •......414•44•11 oIali C certify that I(we)ocwpr-'; .' our)principal
place of residence or a',.re)buying the following described real property under contract for w r iJC I p HRrn stead Property Tax Standard
Deduction is hereby claimed on the date this applice5on is signed, U WI oo( turn). I(We):
❑ Own. ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corpo •
❑ Have a beneficial interest in the trust or the right to occupy the property undo:GIB nal residence trust .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. COUNTY AVD
•
Li 4 ..s r ift=,_ _ :_7C-1:.. :' 2: .:CLAIMANS INFORMATON :—7-:.3."7"5-
-.,. a _t_ _. .'_e r- °T ': {•-4 x
Name of dainant(legal name) Teepfone number of din an
( )
Sadal •nty number of lain t Oast Thee dgds) Uivds license/be:..5mson/O:1w number r "/�) I Issuing Slate f^/
a 1, a -3 o W'r-.nl uman eyys) H u 1 6 1 - �,-v
Name of lair ant' 's•' nymg l / VV „TC -_ �_
Social Sevafy number of claimant's use use(vas five digits) Drivers Gcenso/Itlen:.5cation/Other number Issuing Sate
a . / of clamants spouse Oast fare dlgls) I�' " - z
E.-; 1-&-.7 :Ltfi—. tai x_ii :" a CONTRACT,RECORDED 71 i, _ J.?t' <_ **-?c~52J 4
If toying on contact.Fee Simple owner's name
Recorder's office where combed Is recorded Record number I Page
kr3 r`f >r�'°a v1':' ' C..:' '_'r PROPERTY:DESCRIp71ON '.31z7:41S-7-Mg4F-a
Cwnty Township Taxing dste t(city,town,tot )
Parcel number Legal desaip;ion Is the pryeety in Guarico:
Real properly ❑Annually assessed meSe tome(IC 6-1.1-7)
If any portion of the nsidet al titan or the and rot excaedag one(1)acre that in- eda:ey surrounds that encze is used to produce income.desolbe the use and porion
of the property utilized to produce i co me.
6 - a -Ss- 3 - we 39a_oig— HO—
Seta Caeay T wnah� 0 cM 02 /� r ,/'�� rr��/ sp{���) Is claimant vacating a homestead?
aa�� � QQ a i�Tl Q( Ow t " �q ❑ Yes ❑ No
ere ®a; ash-tQI>A �� Qgig cI$ d
ere certi cite a site a en are true,ce and com late.
(a •
Address of contact(nrmterand Se(alit sets,ail •-) �of vamled bco•s ,dany(number erxir ueet,city,sate,and ZIP code)
1 • S 11
' ASSESSOR USE ONLY . I ASSESSED VALUE I • HOMESTEAD VALUE , ' NON IESISIUENTIAL.
Land not exceeding one(1)acre immediately
surrounding residential Improvements (1)
Other land (2) ,�,..__ Nrr•-'._.�� _
Total land(line f plus line 2) (3) _ _ _• — -
Residential improvements or Diverting (4) i
Annually Assessed Mobile) _ y
Manufactured Home Garage (5) • _ _
Other improvements (6) x = -''
Total improvements(line 4 through line 6) (T)
Total value (tine 3 pus line 7) (6)
I hereby certify the above is true,correct, Signature o Assessor Dots signed(month.dal'year)
and complete.
Verifying anion-Synabn of&elor Data signed(month,day yew)
i s - .� _11'i STANDARO DEDUCTION'ALLOWANCEstat- ,,„s;�__.
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-21-12 to a mobile home $
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not exceed on all(12)of the assessed vat the mobile home or manufactured home.
Signature of Putt p 1 Draisgn� rwc Y.Yelcv
1wl 'Vl1__o/ `/
DISTRIBUTION: Orinrut.County Auditor,Fie-Stamped Copy-Taxpayer