Homestead_Beck CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
i` A !late Fenn 5473(R17/1-15) HC10
Resaibed by to Derennent a to Cavmrrsl Finance
INSTRUCTIONS:See reverse side forfiing brfruceons.
NOTE Telepone.Sodal Secants tYrvets!carte,state ifen65calipn and federal numbers am confidential wider IC 6-1.1-12-37. eTn
I(lN2) r e Q a- certify that I(we)owl ' e g
• place of residence cr am(are) the following descnbed real property under contract for which a Homestead Property Tax L
Deduction is hereby calmed at the date this app&ation is signed, (date CO s1gnanlrgl7.I II'Y
own. ❑ Am(are)buying under recorded contract "" 1 3 201 7
Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the hoot or the right to occupy the property under the terms of a qualified Person d ence
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
-
Canty Township Ta&y QmGaY VwdId/Cp-J/-7 'n o'' /]• -
Petal numb lt�afg-dY_/d/m��peal�� 46 �r Is en Finnerty ii quest=
/'/021.0i/ /-f�s�e //7yr y PIIYaw ❑Mnnstr assessed home(IC 61.1-i)
If any portico a to rasUerm>e aanre a be land not emMng ore(1) its samaahn etrr Satan is memo eohp imam debate tie use aye potion
of en pnyaty wTaxd b podax bas,
aT lo- /-9-/g - /Oo? Grd lo3g -007
t yr ax RROPERN-OWNED-,ELVHEREBY CLAMIANT
Sate.
CO1 ,,aid TOmtdup Is claimant vacating a homestead?
❑ Yes ❑ No
•
Senate
I hereby Mg*the above statements are true,correct and complete.
Address a end(mmtere,d&beet oily,aye.act ZIPmde) K hoc dory flambe ad street,dry,sib.em ZIDeade)
'6 6u 302 i 7 Lied 2/1 6 •
.ASSESSOR USE ONLY ti' -_ . ) ASSESS ALOE -74 '1OMESTE'DIA LUE"-,;I .NOrbRESIDENTIAL
Land not exceeding one(1)acre Immediately
surrounding esidentlal Improvernenb ( ) F ta" . .y
v T
r s _Other land 0) -ti _tt
Total land(line'?plus line 2) (3)
Residential improvements or DwelAng (4) bt, t• 7`f
annually assessed mobile I '
manufactured home Garage (5) Y• -1 _ s.
Other improvements (6) ,777:.17*)12307-5.15,,7tC333IIi.1It
Total improvements(line 4 through line 6) (7)
Total value (line 3 pies line 7) (6)
I hereby certify the above is true,correct. Spaave Q MU5SOr Data decd(eoriq del:yea)
and complete.
Veiybg mien-Santee aksivs Dab dated(name clay year/
�� . ,��.z.•STANDARD DEOIICTION.ALLOTVANCE __ _ __- _
20 pay 20 Lesser of 60%of the assessed vane of the homestead a 345.000.
Notwithstanding any otherpmvfsie;the Sam(0 the deductions provided in IC 61.1-12 to a melee home S
that u not assessed as coal property orb a manufactured home that is not assessed as real property may
not exceed one-hat(t/q of the assessed calm of the ntota7e home or manufactured home.
Swinge e i) Dab Arad(ma*dry,yes)
24,. o f 4 /3-f'
. DISTRIBUIIMI:Original-CantyAvant RN-Stamped espy-lexeyer
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