Homestead_Ziliak ,,f .- CLAIM FOR HOMESTEAD PROPERTY TAX FORM
STANDARD/SUPPLEMENTAL DEDUCTION
Saba Form 5473(n17 f 1-16) MCb 4
Probed by Ole Department dLuxarcwarm!ntrss .0
INSTRUCTIONS_See reverse side tort rng instruceons.
NOTE Telephonm,Soda!Secaig(rtrlver's Ecerae,state art and federandengcafton manners are corardentitd under/C ti 1.1-12 37.
CERTIFICATION`STATEMENT
• t(We) a -C. •
P - - certify that t(we)occupied-- .' -•
pbace of residence a am(are)burying the . r described real property under contract tar which a .11 , :-,.
If
is hereby cla(n>ed on the date this application is signed. (date of...r_,. - b )• f,
'L.t Own. 0 Am(are)buying under aurae contract.
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. n
or
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal veal.
❑Am(are)the shareholder, partner,or member of the entity that owns the property.
Inn-OR
,-
Parcel camber Leas!daufp:at 122L(
%' — 3-/0 6 3u. , Arr ritesli= ❑A, ,,assessed asoblahome(QC 6-r.1-n
yang Idiom of iha resider:Sal tertscese or the land not cower ore(1)aaa bat knmedceoly sumuids that structural*used to pa«hrce income,describe he use and ponce '
of do,Araby Lobed to produce Icszaa e,: 9 1`
ac:„.
- ‘ •
.4r) 10-‘ 4-1 -LA co-co a.
SPROPEE2TYOWN EDELSE'N:HER B-CLAIAtAilt.
stmo,Carly.and Tornshtp Is claimant vacating a homestead?
,/�Q Yes 0 No
I hereby certify the above statements are true.Cored and complete. fr7 Jl
Abyss of axeas(water and shoat d0:a snd ZZPmda) Address ovambd i..• o.1,3mq Intars6erand street,arty,Mee,end W ode)
• NOti•RESIDENTIAL.
ASSESSOR USE ONLY _ .• t ASSESSvED VALUE HOttESTE:O VAtUr .41.. - VALUE
•. r
Iola,land Ulna.1 plus firm 2) (3)
Residential Improvements or r..annually asseseed mobile/
K::--.d 4.V2-''.'�•c{;i Va iftT•SIA, ti
Manufactured home thettbe (5)
Tots!Improvements(line 4 through tine 6) (7)
signora of Assesses Oars stoned(moult;day.yawl
I hereby certify the above Is true,correct,
mut complete.
Vertyleg Mon-Stratum of Autfex Otte signed(worth,day,Year)
i
• h t 1 �i
,,• _ _ - _ , '' _:`.STANDARD,DEDUCTIOIi,ALLOt?ANCE-"1-4,,:' y •_� n`- I�^*L`
20 pay 20 Lasser of(io%al the asaar'ed value of the hotrod or$45,000. . ..
Notwithstanding any other provision.the sun of the provided In IC 6-1.1-12 to a mobile home $ O C T 2 3 2017
that is not assessed as real property or to a manufacbredhome that is not assessed as real property may
not exceed ore-has(Ut)of the assessed value of the mobile home or manufactured home.
•Sigrsa3se L/�/� ESale i Om*
GI SON COLIN I Y AL1MiOR
DISI1IttilOM orig -County A+sddo►.l scrmad Copy-U444
rs w.e..0e