Homestead_Williams (15) .,��2, CLAIM FOR HOMESTEAD PROPERTY TAX 1 YEAR
: ;: STANDARD I SUPPLEMENTAL DEDUCTION e
State Form 5473(R15/5-14) `
W I Prescribed by the Department of local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. ! r 1
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under lC 6-1. i :,!
. .- J+q. •._. .•- _, -s-- . .•.-_-. "CERT!FlCATICN STATEMENT°�^_ ` � - _ ... �
I(We) e_1 � l a/f ) - /t9??g S certify that I(we)occupied III (g cad
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax S
Deduction is hereby claimed on the date this application is signed, (date of sign6y)to). I(We):
Own. ❑ Am(are)buying under recorded contract GI JN/7!
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. B$ON COV
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence 445 1'OR
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
(i' -Tasc_� _`'i `s72 vCLAIMANT(SINFORMATIONrT•,.'?. ->v-_. t'+`'-_ t "
Name of-- R Yal name) Tnhone num.'.ber cfaLtrari
Social Secrmty number of 06570 clamant Gad five doffs) Dui e a Dwane/Identtca;ian l(O�aw number Issui g 5
2 j of claimant Gast five doffs) /JJ ?9 I 1
Name of d s semis.Vega/name) l G7 ,�.1Y/�,vF-
i D l� L7//1417"5 .
Social Secur y number of claimant's spouse(last five dots) Driver's license/Identification I Other n Issuvg
c? '7aa 9 of da'enant's spouse(last the dlgas) r
ti buying on mreract Fee Simple emcees name
Recorder's o6ce where contact is receded - Read number Page
S '° tag garCZ — 3RROPERTY,DESCRRTION:'1 C41, el
1 Township Taxing.• '-/E.; ,fowl loarsf;) i
/ enN 61-10
Paod numbs :Pica Is the , n9ves5orc
Real peoPer:Y ❑A uaPi assessed mottle home(IC 61.1-Tr
o any portal o =tare or the Ian not exceedsxx�yte(I) tat'' t1edl#Was /s�to toed to prod.=income.describe the use aM porim
cite property red to produce nwme. (/� // / ' /
c?‘ ,/,17-//-/co -00,2. ..5n-o r
" . , , •PROPERTYOWNED ELSEWHERE BY CLAIMANT _ •. , - . -
sate,Canty,and Township Is claimant vacating a homestead?
. ' ❑ Yes ❑ No '
!�of�daimara
I hereby certify the above statements are true,correct,and complete. \
Address of not(member and 5r-R sly&Se,and ZIP code) � '��pQ Address of vacated bmnesead,if any((n number and street.etyc stare,and ZIP cede)
�SSe3S- . .c...5- W' \NViLat'f�Sn.y�o-Vy •
•
ASSESSOR USE ONLY. r I ASSESSED VALUE I HOMESTEAD VALUE.- _ NON-RESIDENTWC
Land not exceeding one(1)acre immediately I(1) - -
surrounding residential improvements -—S -- --
Other land I(2)
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I ----- - -_ _
Manufactured Home Garage (5) 3.'-f-J`,' _ ._ __
rat
Other Improvements (6)
Total improvements(line 4 through line 6) (T)
Total value (line a plus line T) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Veifyig action-Signature ofNrdtor Date signed(north,day year)
_ . _ STANDARD DEDUCTION ALLOWANCE v=at'j„pvie-`> -,Z `sb
20 pay 20 I as r of 60%of the assessed vdue of the homestead or 545,000
Nol nthstanoing any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Signuve d Mellor Data signed(=oat day,Year)
DISTRIBUTION: Original-County A:r .t r,Fie-Stamped Coq-Taxpayer