Homestead_Weisheit ?„ CLAIM FOR HOMESTEAD PROPERTY TAX <0
.....i_ STANDARD/SUPPLEMENTAL DEDUCTION FORM
Star Form 5473(R17/1-16) 11C10 /
Hesatbed try tie Depaern tf toot Government Freres
INSTRUCTIONS:See reverse side far any eons rr k
NOTE Telephone,Soda!Secwffr doers kerne,state iden65rafon and federal ideni n numbers am wraidential under IC 6-1.1-12-37y)
! CERTIFICATION STATEMENT
I(We) sit _Z,._ ff � f
certify that I(we) • (our)s� Nea
place of residence a- At)buying the .it. ••dessaibed real property under contract fa which a Han a r_ Tax
�D/ ion is hereby dal-•--•cm the date this application is signed. (date of %1 �W`e�
P�.Owl1. ❑ Am(are)Gryvt9 under recorded contract ��✓.7il.
/❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. �YAI`'�i
❑ Have a beneficial interest in the bust a the right to occupy the property under the terms of a qualified personal residence
❑ Am(are)the shareholder,partner,or member of the entity that owns the property. Oa
iaaNdp Taatp - ( morn
/ � •• •,••.• lade c�PieCd��
/ p RW air ❑MWry messed motile h e(IC6-1.1.7)
Ifairy of re to prom ssaccrne. e.. .mlacaa&igry/(af(1)pae><atf ainedmpa0.reYmne, same ere use am past
*ere mT¢ed to promos mason CA i,% d .
dzi9-�So_ such a . dal/
.`, T}" '"_ � °1 f ',!-reNPROPERTY,OWNED,ELS EWHERE 9Y,CLAIfi1ANT •• °.-u7 r 'e,ZA144
Sate.Carry.and Toen*Yp Is daimon!vacating a homestead?
❑ Yes ❑ No
• Scletn of d�3raa�t n /�
I hereby oartify the above statements are rove,tarred,and complete. e / 94 //r
Add site*mYa*(amtaard street city.site.old Z�coil AOdessd tamesaad. (rra+ter end Rivet,nay. ,aE Wrote)
4o111 E. Wh.fe 0(T< in //a/6sMdf IN 4
ASSESSOR USE ONLY ASSESSED VALUE is. 4OMESTEAD ALUE'3�i ,.-r10'. IUENTIAL'f '*'+:j•
Lend not exceeding one(t)act immedlately� s _s i:R
srrmundmg residential improvements (1) s s� .
Other land (2) . ..il......,_:{.-�,.c.:••,..E
Total land(line 1 plus line 2) (3)
PI t'si ?Residential Improvements or Dwelling (4) y _ .C
annually assessed mobile/
s e s x
manufactured home Garage (Si a y
Other improvements (6) -./,.tNiak<.�;{.,?<"t-"r..,j.7:0
Total improvements(line 4 through line 6) (7)
Total value (line 3 phs line 7) (6)
I hereby certify the above is true,comet, S.oretsa of Assessor Date signed year)
and complete.
VedWg wan-Sgneure of/wdar Dated kpiji
.a-.. STANDARD,DEDUCTION ALLOWANCE.1,....,.?' C -• - _ere :,:,,,57.,,,,,,,16/4;',,n
20 pay 20 Lesser of 60%of the assessed value of the homestead or$15.000. y r 7 2017
Nohdhstanang any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobgd home $manufactured horne Matta one-hall(1/Z Noe assesed�d vsasieS a home Or'manufactured home teal plopam may G/BSOA,,
not Signse of AucEtt Dale dpi(mordedaSe_, T'6ep
DISTRIBUTION:Original-County Alex,Ile-Breed Copy-Taayala
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