Homestead_Creek (5) „ +..., CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
.i .:;* STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Pam 5473(217/1-16) HC10
Prescribed by Department/Local Comment Rance
INSTRUCTIONS See coven&side foaling insbucborms
NOTE Telephone,Social Seam*driver's bwrse,state idenbaostion and federal fin numbers are am5cknffal under IC 6-1.1-12-37.
. I(VVe) certify that I(we) •
pin of or am(are) the following descnbed real property under contract for which a Homestead T
Deduction is hereby claimed on the date this application is signed. (date o1 signaMe). I(We):
❑ Dan. ❑ Am(are)buying under recorded contract JUN 1 9 2017
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a benefidal interest in the trust or the right to occupy the property under the tarts of a qualified personal residence trust
❑ Am(are)the shareholder,partner,or member of the entity that owns the property. 4 e
_
L . —
Cony Remade Tamp dseict(ay,,fawn,beeshb)
/ 4.
Pawl note - leggai desobam /•O 4 m
la .... in Riesearr
ryl
/ ' SE SE V-3-lz ❑Real accmy ❑A. ._, assessed motes Kane QC Sl.l.n
tam portion a en residential Gumae a an last not mxe6Pp me(1)sae mat rmledieey sumwMs that atrudara is used et aodse mama,desalts ae use at caste
a In property mTmid is arm lassie.
a6, - l7 0 8 - too -00.5. 513 — 001-/
r,.-.7,.:7 r” va- `,PROpERTI'•OVINED ELSn iERE OY OCAsiA-h A o'er`, a-tt
State,Canty,and Toe/retie_ . Is dahnmt vacating a homestead?
❑ Yea ❑ No
Sgmre of dement
I hereby certify the above statements are true,correct and complete. /`J�'` '^,({�J//�ES'/�/Yy�(/C////� 02a, .
Address a mean(mmlbeast Mae(dye state.ant ZIPmele) A9�s of vavbdl � �. (nurnb and sneak thyWaate,end aucaY)
ASSESSOR USE ONLY I .ASSESSED VALUE.!- HOMESTEAD VALUE'. NO.Riz2NTIAL rt
st
Land undmp litleentiaall tin)proaenenb roomy' (1) V �'F' 4 v
tie
Other land (2) n _ :_4_:u_`f
Total land Vine t plus One 2) (3)
3*;
Residential annually Improvements) Dwelling (4) t ---R
annually assessed mobile/
manufactured home Garage (5) _- ____
2i_^�?4?mss`-."."r. _.__ ..-.
Other improvements (6) . , '�_V--y� -
Total Improvements(line 4 through fine 6) CO
Tool value (line 3 Piss line 7) (6)
I hereby certify the above is true,correct
Signature 0/Assessor Dab signed(eaan,my,year)
and complete.
Vetyng actin-Signature cleating Oats sigrytl(naafi do%Yea)
20_pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
AbMrmstance g any other provision,the sum of the deductions peeked in IC 6-1.1-12 b a=bee bane $
that Is not assessed as real properly orb a manufactured borne that is not assessed as ma!properly may .
not exceed on -hat(1/p of the assessed vale of the mobile home or rtuadaclnM home.
Swam aquadM�( / / 4yy.-c- Date dons(ant%da,,lid
DISTRIBUTISC' ON:�-�AUdINa.IiSuTWad CO%-Taxpayer .
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