Homestead_Morgan (8) .e-ice CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
rippptzy�..........;��,;x STANDARD/SUPPLEMENTAL DEDUCTION FORM
r r Ste Form 5473(R17r 1-15) HCIO
Renamed by to Depaonaa of Law Government Fears
INSTRUCTIONS See reverse side bard5ng fir sbtcbwa.
NOTE Telephone,Social SearilS ddye/s lcerae,stab nierfiricabon and federal identffication numbers am m6denhal under lC 6-1.1-12-37. .
I CERTIFICATION STATEMENT
- I(We) d f l! -4� 1.1 t-� ' 4L.. 4. .:.L that I(we)OCWPed as my(ou)p
place of i1,-.-a am(are)buying the following described real property lutd- tntract for wtlid)a Homestead Property Tax 7
Ded ',Its hereby daimed on the date this application is signed, (date of sicolure). I - f 0
❑ Own. ❑ Am(are)buying under recorded contract "'JO*' 2oF?
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. O• ^a
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal resider.: .. �,.e■
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. F
O/T
Toersip Tarihp ray.awn.
Of u90 _ .
t—�(] �y/n (q_epaty a(I v /!� /G-3- 9 "Perot ❑Annaey assessed mothtYAe(IC 61.1-r)
Ifer♦pwbm d ae redlerps mecum oeslM as eae±ng an(1)are cow its yanwtls that shumaa Is uad m prints iema,dasatte ae use aid anion
d d((y7r rIy tebs to pronto&come.
a76„..aQ-70-aefo- 40...?. /7G- 66/
't;' --PROPERYOVJNEDELSEVTHERE 6YCCFINANT� _ _ -
Saa,Canty,ad Tonebp Is Claimant vacating a homestead?
❑ Yes ❑ No
I hereby certify the above statements are tae,correct,and complete. v2olinktaataimant 1� , All
Address d contact(rrmbaeal Meet OM/date,and Wad') vamladt drR'L s er ZlPCad)
ASSESSOR USE ONLY _ - i - ASSESSI-O VALUE _I ' 'HOMESTEAD VALUE , I _ -(.ON RESIDENTIAL,
Land not exceeding one(I)acre immediately ediately Ss 5. � .p, -
sunounang residential bnpmrenerb ( ) " A.cv , s
rd y
Other la -
Total land(line 1 plus line 2) (3)
2
Residential tr°pr°v°aerts or GwmsN (4) _r.'-T1,:tY '-_iac,..PaS'-5}, '
annually assessed mobile I
manufactured home Garage (5) s .F
W
Other improvements (6) 4-T:'1 .1_'
Total improvements(lice 4 through line 6) (7)
Total value (line 3 plus line 7) (a)
I hereby certify the above is true,correct, -we of Assessor pea alined(Month,dry,yea)
and complete.
Vateso cyan-SIgatse cAudar Data signed(Mora day,leap
( - a— v aewi ....i,.-- ZaiYLY.- -t ..,,,64,.v.... . ,
20 homestead
pay 20 Lesser of sat%of the assessed value of the or 645,000.
No[riMstanirp any other-provision,the smn of the deductions provided fn IC 6-1.1-12 to a mobile home 6
that is not assessed as real properly or to a arena-adored home that is not assessed as mar propeM may
not exceed ore-ha!(I/O of the assessed value of the mobile hone ornsanoactrasd home.
Slghaare of Audit* Date slgnd(a nth.day,yea)
DISTRD3U11ON:Occiw-Casty Auditor.fisSTSged Copy-Ta rays
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