Homestead_Russell I � i� CLAIM FOR HOMESTEAD PROPERTY TAX �� YEAR
` �;, STANDARD!SUPPLEMENTAL DEDUCTION _
State Form 5473(21711-16) HOW
Prescribed by de Department of Local Goverment France
INSTRUCTPoNS`See reverse ale for fling bsbuc5wts
' NOTE Telephone.Soda!Sam*disera icense,state lden55cadon and federalldefmfaaUan ranters are c nfidentialunderIC 6-1.1-12-37. \ •
CERTIFICATION STATEMENT \\
I(VUe) , a - v •
certify ry that I(we)ocalpied as my �.� .�' ••pal •
place of residence or am(are)buying the fSSowing descnbed real property Tuber contract for which a Homestead P • ..rd `;
Deduction is hereby claimed on the date this application is signed, (date of '
O'Own. ❑ Am(are)buying timer recorded contrail.
•
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the bust or the right to occupy the property trader the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
If buying ce contract.Fee Simple carets
name
Remdels rase Were contract is recalled Rend number Page
s Casdf Toast Tare
PatfJ nmbsr
ePton ✓`-'1 -P❑ReaOS ty
�a
/syp)aue
0 assessed ramble acme(/C 61.1-7)
a am ponce of re resdetal strums*or the tad and ducting are(1)am sunamds Mn settee is used to produce income describe em tea aid parson
of the mpay crazed is podoe tense.
e'(o / a / 30 a - ooa 67 caRR
-- .._.
.--.... - "� - 'PROPERTY OWNED ELSEWHERE BY C IT.IWANT ._ .. . = >.. . 77
Rata,Cant.and Tarmtdp Is claimant vacating a homestead?
❑ Yes ❑ No
I hereby/certify the above sstate lures are ttrrruu/e,,,=tettttt('/and
/(com�/pll'ette�.��� . -.. U7, r jar f f•
_ I I ( eata't 1 s� tide/ f 111 sW'✓' tt Anima 1 r��✓ d any(miter eta/mast ah stab,end ZlPmct)
•
ASSESSOR USE ONLY _ ..i ASSESSED VALUE_,- _I HOMESTE DVALUE.,I.. NC"'I-RESID NTIAL
VALUE
Land not exceeding one(1)sue Immediately y " C -
sussoundEgresidentialimprovements (1) - cs -41 ,
Other land (2) -j _.`r;4ii �._
Total land(line 1 plus line 2 (3)
(4) a }_
Residential Improvements or brmmna A ice„ .°'r a k_
annually assessed mobile I -
w ia
Z
manufactured home Garage (5) „ a:_?ei'.ir.:yr. t. =:'t
-Other Improvement (6) to . j.;. -t
Total improvements(tine 4&sough line 6) (7)
Total value(line 3 phs fine 7) (3)
I hereby certify the above is true,correct,
Sigr�tJeo essoc Dee aam0(nnae/y MX lead
and complete.
Waving action-Sianatue standar Dale erg ad(man tea lean•
ST^NDARD DEDUCTlOi1 ALLOtNAWCE• -
20 pay 20 Lesser of 80%of the assessed vdue of the homestead or$45000.
Nohathsbndl g any other provtsiu;the sum of the deductbns provided in IC 6-1.1-12 to a noble home $
that is not assessed as real property or to a manufactured home that is not assessed as seal property may
not exceed ore-hal(V2)of the assessed value of the mobile hone or manufactured home.
Si hose Gee signed(urea ctrl:yea)•c >/L/o � � -. Data
7- o4/ / 7
assnaamoN:Crone-CamyNrarr,rie-Sawed Copy-Ropayer
Page I of 2