Homestead_Torres a. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION
v State Farm 5473(1715 7 5-14)
Prescribed by the Department of Lobel Government Finance FORM
INSTRUCTIONS:See reverse side for firing instwc one.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers am cm5denti.1 de xi.1-12-','. :':
r-.74. - ; .'i",_/ "_CERTIFICATION STATEMENT , •r _-`• -1� _ . (-I-1:3 nii -Ir 1
I(We) ILL " - i<• - certify 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 HomepNdyPrApgty.Try{ tandard
Deduction is hereby claimed on the date this application is signed, (bat n 4 Me):
❑ Own. ❑ Am(are)buying under recorded contact
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporationf.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms oi3,gali OUNTY AUDITOR
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. (il 5
.'.
-; _-.
It buying on contact Fee SMpk comes name
Reorders c5¢where contract is recorded Record number 1 Page
rL_ SRROPERTY,DESCRIP•TION;` -"R:_'- _it_ -cc
Camay I Tornsttp Tying dSrica Oily,(own,loots*)
Parcel number Legal description I Is the property in gsson
,t WI* 4 Y(YS prope•'ty ❑AnnuaN assessed meNe tome(IC 61.1-n
If any patian of the residential strud-ae a the land not exceechng one )arm that irons/tern surrounds that etCMe is used to produce income.des.The the use and porion
of the property v.Taed to produce nca:e.
446,- 11 - /a -/oc' - 000 . 5 a 6 - o .LB
PROPERTYOWNEDELSEWHERE BY CLAIMANT _ _ _ _ _ •
Stab,Cary,and Towns/tip Is claimant vacating a homestead?
. • ❑ Yes ❑ No
roes of claimant
I hereby certify the above statements are true,correct,and complete. IA iI a nitla E - J(-Q.4
of contract(number end=eel,ay,stare,end ZIP code)co Address of vacated haresbad,d any(number and street rM.stab,and ZIP code)
' ,•ASSESSOR USE ONLY I ASSESSED VALUE . I HOMESTEAD VALUE NON-RESIDENTIAL
Land not exceeding one(1)acre immediately s - II
surrounding residential Improvements (f) _ _ �
Other land (2) �`,.... A.
Total land(line 1 plus Ilse 2) (0) _ -_ _ _
Residential improvements or Dwelling (4) I 'ni
Annually Assessed Mobile! - --p7•
Manufactured Home Garage (5)
Other Improvements (6) '•>;.-`-_tee �___
Total improvements(line 4 through line 6) I(7) I'r
Total value (line 3 plus line T) 1(a)
I hereby certify the above Is true,correct, I Signature of Assessor Data signed(meat;day.year)
and complete.
Vadyig action-Signors of AUdta Date signed(month,day,year)
a••••? ' _. -_'��a t,,,_nISTANDARD DEDUCTIONAL'LOWANCE =::• Y Q•ii Ir,
20 pay 20 L><mr of 60%of the assessed value of the homestead or$45,000
Not'Mthstandi g any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not exceed one-half(l,2)of the assessed value of the mobile home or manufactured hone.
Sgne/ace of Audlor Data signed(north,day,year)
yy
DISTRIBUTION: &s.r Tie-tamped Taxpayer