Homestead_Matsel CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION Fay
Stab Fam 5473(R)Tr 1-16)
HOW
Pravabed by the Deperfmad at Local Government Finance
INSTRUCTIONS:See reverse side lerdaag instructor's •
NOTE Telephone,Social Seaedx drivers Ecense,state/0en55-a5on. •federal- .....-.... numbers are cone.- uncle i C 1.1- 2 E 7. • r r _
CERTIF IC?TION STATEMENT
I(we) ` J.t fli*_ U IErna['l, certify that I(we) apal
place of residence or am(are)• • '. e fogowing... •_.real property under contract for which a HomeSt�a2f�Plbp�+t�•I�axrrStandard
Deduction is hereby claimed on the.<e this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract
❑ Am(are) entitled to occpy as a tenant-stockholder of a cooperative housing corporatism,, r�(l��A1 ern
❑ Have a beneficial interest in the trust or the right to occupy the property under the teals dPdgt carThlTeti EESCR
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
ti bb g at catad,Fee Simple cranes nave
Remdss office where o tads reraded Rental number Page
•
• PROPERTY DESCRIPTION • ,7 - b •
•- legal dhe.v r:on�T11 '"Y.`1-1r�, h be prWedy in gond=
-% `•.,J .• aIV .�` O-tDac) N.RedpWaty ❑Armen assessed mobile home(1C 61.1-7)
It any portion d the residential bastes or the tad not exaedng COG(1)aaa that emedzsN samndt• Armen u used m produce imams,describe be use and paten
d the property v'aired b produce imam.
•
''PROPERTY,OVyNED ELSEXMEREBYCFIA1ANi Tit. w "I.•
Sae.Carty,ad Tawnshp
Is claimant vacating a homestead?
❑ Yes ❑ No
I hereby certify the above statements are true,correct;arid replete. `m m 1 _a� 0 „►_�
da'ad(aoagam.meee db:rasa.arbn ostel 'Nlly% - - - . .•...:
1
ASSESSOR USE pry _ .. ASSESSED VALUE: '+�' • HOPIESTE D./AWE._ NOtl-VALIUENTIAI
Land notesdeding one(1)eat Immediately
`
surounle•ceding residential (1)e• .:M (1) E
Other land (2) r k =
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile I s manufactured home Garage (5) ' - . •
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pis line 7) (a)
I hereby certify the above is true,correct, Side of Assessor Car signed(moreq MX seat)
and complete.
Velma amen-Siaolae d/wdtor Data spored Mora day,seal ,
_ ' ��, 'a-'-� ST"I.OFRO DE15UCT10—lLOINANCE` 77;�7.-- -��-1"-r-n
20_pay 20 Lesser of 60%of the assessed vane of the homestead or$45,000.
Notwdhstatd g: other provision,the stun of the deducffins provided in IC 6-1.1-12 to a mobde home $
that is not arse real properly or to a manufactured home thatis not assessed as realpopedy may
not exceed• - • (/2)of the assessed - of the mobile .-, -ornanufactued home.
SRI
DISTRIBUTION:Crigisl-CaseyAudta,Fs-Sangtl CWy-i
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