HomeMy WebLinkAboutHomestead_Tooley (2) - CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
r, vy.I,� STANDARD/SUPPLEMENTAL DEDUCTION
``dal State Form 5473(81711-16) HC10
`SR_f"'f Prernbed by the De eetnem or Load Government Frtw
INSTRt/CTTONS:See mesa side for Ong instructions. i
NOTE Telephone,Sodal Secwity divert tcense,state Ace fdadon and federal idendladion numbers are cwnbdadial • •6-,s-1 y 37.
I • CERTIFICATION STATEMENT
��
1(We) Vet i1a2_'_. cattily that I(we)occupied as my(our)papal -•
place of residence or am(are)buying the followi I described real property under contract tar which a HornesteadieNat2 T•g*,
Cedlyds 4reby claimed m the date this application is signed, (date of signature). I(We
66/ww/11.. ❑ Am(are)buying under recorded contract
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. /, �i'>r-re
❑ Have a beneficial inteleet in the trust or the right to occupy the property under the terms of a c� rr�'
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. k. -.••-• IT DR
Canty Township Tasbg dhsid Key.ben Mendip)
Paul ruiner legsl demisted Is the property b dumb=
❑Red prga«tY ❑Arasaly assessed mine.tine(IC 6414)
II any partial of Ole readatd>SUCpe maw land not eaatchy me(1)as eat ianeda:N sprWtls Mat some Is mere b ponce imne describe to use and cabal
of Ma popnty ebbed to produce imam.
_ . W • • 1— a - 03- oI - 8G ^-OD
i-_ 1 ri.r+-n- =r.-4T A _,i "p,ROPERTY OVA EDELSEWH ERESY CLAIA1ANT~ie'�' '! . .. F,:p•. ` -.T'Y`
Sum,Way.and Toenship Is claimant vacating a homestead?
❑ Yes ❑ No
es
I hereby certify the above statements are true,coned,and complete.
n\-154/401/4:C.,1 .
Address of contact(maneaest sheet dry.dye..end Z(Pmis) Address&sate lvreseJ if ern(rmdvat M:sr.and LPwm)
• _
t••ASSESSOR USE ONLY _ • ASSESSED VALUE ": -HOMESTEAD VALUE;_,I' ` NON-RESIDENTIAL
VALUE.`
Surmundmg residential hn )proremems latefy (1) 5 citr4 4 M,._1<,^
Other land (2) :T-Sib SRi_ 3:i;_-R_ti.foo':
Total land(line 1 plus tIne 2) (3)
Residential improvements or Dwemng (4) �?>.°t - -
mmmgsiredhWmoWtl -,: •-•
manufactured home Garage (5) as ._�F Y x
Other improvements (6) *•`c'.-x„ E.._Sr.-"_P(Kxt
Total improvements(line 4 th rough line 6) (7)
Total value (line 3 plus line 7) (B)
1 hereby certify the above Is tore,correct.
Signature of Assessor Oat signed(maven,69:year)
and complete.
verifying action-agnate.oAUdtar Date*Ted(mina day,)ea)
20 pay 20_ Lesser of 60%of the assessed vague of the homestead or$45000.
Nohelhstanceng any Other provision,the sum of the deductions provided in IC 6-1.1-12 to a nbbile home $ •
that is not a ssed as re al property orb a red home that?no assessed as seal properly may
rot exceed (1/n&the assessed Va the rnobda home ormau0acuaed home.
Sgwtae&bud
1 ore dpnea"(nxrth,� �
oIsTREITION:Ongial-Carty pdr, ie Copy-TamerM
Page tot 2