Homestead_Kasprzak CLAIM_:'FORMOMESTEAD.eROI?ERTY TAX _.'>. �:YEAR•.t.-
N.‘,or STANDARD/SUPPLEMENTAL-DEDUCTION FORM
C.4.
Stab Fan 5473(R1711-16) HCIO
Presaaed by me Depebreei Of boa Gmerm_^ra Finance •
INSTRUCTIONS:See reverse side forI6ng tsbuurlms.
NOTE Telephone,Social Seaaify,driver's 6rense,stale iden65caUon and federalidenace6on numbers are cottdenfal under IC 6-1-1-12-37. • .
CERTIFICATION STATEMENT•I M e) •A - 4'-- • ,. _.e • i - 0, •-certify that l(we)oca pied as my(. }fp r
place of residence•• am(are)buying the followi •described real...pert/under contract for whirl a Homestead Property 14vd
Deduction is hereby claimed on the date this application is signed - -• - ' (date of signature). e
❑ Own. ❑ Am(are)buying under recorded contract
❑ Am(are) entitled to occupy is a tenant-stoCdidder of a cooperatthe housing corporation. AUG 2 9 2017
❑ Have a benefc al interest in the trust or the right to occupy Vie,property under the terms of a qualified personal residence bust
❑ Am(are) the shareholder, partner,or member of the entity that owns the property.
: ....
t •
Reardee m ts o5ce where act is recorded . .• Rend amber Page
no � , mstat( y{fuq foendep) - - �..r•c+~ •.� -, PROPERTY DESCRIPTION:,r - ', _ -"
-Ca°y -
• CM)2fr:
Pacer ram r Legal cam=
• lr^t '7• f- Is the ptaperynguasWre .
K k�QO `S� 3 r.1 a=d prcpeity ID Anna assessed mnbee l,o,rc(c 6-1.t-7)
It any pan,of the resismet staare a the lag not erceevEng eel(1)sae Mat immelysinmnds thatetflae is used to produce icon: des the use arid parm
M to property,riled to produce bonne
. 2. r�-.//- 3 /.- 'V c0 - oo L /.9U -cal .
s3 P : _ ",r, , ° ":01-1 r,PROPERTY,OWNED ELSEWHERE BY CLAIMANT: - 12'5.T-,? �L ti:,••r7.(.
Sae,Cant.and TOdmNp .e. .s., 7.' li`daimattveotinge homestead? / %�
❑ Yes,ONo ��` O
SglaLe"W •..
I hereby certify the above statements are true,correct and complete. v9•--��:(-.
Adtessct=Met(number end sheet atj%.. :are ZIP--- r Ow gAls vi Mt Ad3-essof Bbd ;a�('shook brimurea)
5laa5,I41 /. ,ice 97615. > : .
_ ASSESSOR USE ONLY ASSESSED VALUE i - HOMESTEAD VALUE-•.7- NON-RESIDENTIAL -
I. ' VALUE
Land noting ed(ng one(11 rove eats - .NY r :' .y -, - ,yr r.,-.
surrounding residential improvements . : (1)F'"'' x r Z .rt yg„y;
Otter Wnd . . - . (2) • - _ a<�s-erJ: :c . . ,-.
Total land(line 1 plus line 2) (3) - - : • _
Residential improvements or DwaRing (4) ''• -T-(�`.•annually assessed mobile I _
mrn,liacture`d home- Garage (5) s _ e' V
Otherimprovements (6) ' �-u :.i lr i e
Total improvements(line d through line 6) (7) • --- - - -
•
Tool value,(line 3 pee line 7) . (8)
I hereby certify the above is true,correct,• SgnaitaeclASsess" Date Vgned(nnt)t 6y.Year)
and complete.
Vmxlgarmm-SInetse etk•Sbr - ®
sig, ( daY
- '} _ - !STANDARD DEDUCTIONALLOWANCE -
20pey_20_ Lessaof60%of Oceassessed vane of the homestead of$45.000. _ AUG 2 9 2017;•
NotsMistaneg eery odler provmicrc the rub of the dedrrctlwu provided in it 6.1.1-12 to a mobile hem-
ome - S
that is not assessed as real properly or to a manufactured home that is not assessed as real property may
not emceed one-ha!(1f2)or the assessed vakie of the mobile home or manufactured home.
Sgvre NNeShe &D -t- I— -! -.9••r� '1Jr;;T,l . ,I
S2D224 c Co( GI:so. eel INVA9JITOR
DISTRIBUTION:Original-Canny A VSta.Fie-SurL apt-Tagwya
Page 1 of 2
• CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION aHCIO
oy Sala Fccm 5473(R17/1-t6) HC10
^� Resaitaa by tt De ameea of Lace Government Femme
INSTRUCTIONS See reverse side Robing ingrucfrons.
NOTE Telephone,Soda(Ssa,dx threes bcense,state idenffacabon and federal qua tate:on nwnbes are confidential under IC 6.1.1-12-37.
M(e) Ke//�/ M 4- 5.4p-icy /fo p r z e k certify that((we)oca(pied as my -
place of residence fir am(are)buying the foeowind described real prdpesty under corkhdct for which a Homestead Properly
/Deduction is hereby gained on the date this application is signed, (date of signah/7e). �L�
�n
Own. ❑ Am(are)buying under rearded contract
O Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. AUG 2 9 2017
❑ Have a beneficial interest N the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholde, partner,or member of the entity that owns the property.
Carer Tranship Taxing dStrt(city,pan tranship)
Pats nmmer ISO dnessaapS ii /(1 LO t Is the property question
QP 1.Jr 3� r / eaIxwertr ❑Amway aasmlO entie home(IC 6-1.1-0
If any carbon ci the rmpetem saumse a to lap rim erasing cod(1)me bet ktime46tdy rama,ds6,m mamseu used to Pedro biome,desalt*the use end whom
m be property tt.Ltrd to precise income.
2. ep- //- 3 / - 00 - 00 94,90 - oar
�a. DEL
• "' 'PROPERTY OVI\ED ELSEWHERE BY CIA IRIAnJT°- -' �-
Sate,Caiiey,and Tormedp Is dainant vacating a homestead?
❑ Yes 0 No of
I hereby certify the above statements are true,erect and complete. >4-At/:
Addnmmmaam(mrmhirmrdsaeee dry, andLP-•• —
rrl- A - C.a_�u*•'t.a
K/ /y� /weA(S v/ - Address of rented • ------ i f rimy(amber and sweet • ,sate,at =cods)
rll eOW, w r/• t/Ac c,) . 7 as
ASSESSOR USE ONLY, ,,.I ._ASSESSED-VALUE • HOMESTEAD VALUE ;`l NONR VALUs '-
exceeding Land not ) S ak -skmoundmg res nt almprovements 0) s s- :