Homestead_Meyer ,fir CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r,. STANDARD/SUPPLEMENTAL DEDUCTION FORM
` " Stale Fain 5473(R17I 1-16) HCIO
`� Presalbed by the Department of Local Goverment Firm
INSTRUCTIONS:See reverse side for fang insb-uctions.
NOTE Telephone,Soda!Seaaiht drivers spad&state adatli5cabm and federal i ffian mambas am wredtis'al under IC 6-1.1-12-37.
�►.7 CERTIFICATION STATEMENT • -
I Mk) ��1e=yhL!af-7_l W A_ . • certify that I(we)occupied as my(our)principal
sr place of residence or am(are)• the following.t. .-.nil property under contract far which a Homestead Property Tax Standard
Deduction is hereby claimed an the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)brying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest In the trust or the right to occupy the property under the terms of a qualified personal residence test.
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
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Township Tasty drWIa(city,lo.n,fo.mldp)
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Panda ranter legal loser `perk Its the property F �ac pO
❑Real aopeny ❑Annually assessed motes lm.(IC 61.1-0
If any portion of ae residential structure or ere land not easing one(Dace that trme&amy surnamts that Mumma Is used to protium income,describe the rate and anion
dde properly raised In pond ce imne
, 6_ -1a- IL - 900-OD - 3O9- O21 •
_ S'FROPERTYOWNED ELSEJWHERE 9Y.CLAIh1ANT _. p�.i3 -.T.
Sze.Cary,aatrwmNp: -Is claimant vacating a hanestead?
ate; ❑ Yes ❑ No
I hereby certify the above statements are sole,correct,and complete. r/I(�/_ �7/��'�!{�(t....('
•• •.camp Master end street di%elate,sod Won) Address of marled am Enter AMeet CM.+tab,and ZIP code)
.Z_ 9Y3 E 56V IC • ' 69
• -- 'ASSESSOR USE ONLY ._s o .1 ASSESSED VALUE,_ ;1 HOMESTEAD VALUE_ _ NON:R 451UEtvTIA�_
Land not exceeding one(1)acre Immediately (— n . "•4 surroundmRmmemalbnprovamarrb 1) :._-A,4t t ;_
Other land (2) 44sx,cs=_ e=__,r._.
Total land(line I plus fine 2) (3) lay{
Residential improvements or DwellIng (4) i _ .i H 1-.-;"•t'il! -•
annually assessed mobile I
manufactured home Garage (5) 57,n l '...): <C.4
Other improvements (6) a to jam;c 71 .75. �.;:Oltl , �Y (j
Total Improvements(fine 4 through line 6) (7) //////!
Total value(line 3pda line 7) (8) �h` ,�
1 hereby certify the above is true,correct, - dASSxaor G bra J trtr A
and complete. �J OUNTYAs inn rOR
wnfykg action-Sidman oAjddar Date and(mash day,year)
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or$45.000.
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Notuebsta ding any other provision,the sum of .provided in IC 61.1-12 a a mottle home $
that is not assessed popedy orm a man M•red hoae that is not assessed as real poperfy may
not exceed one-hat a the assessed vane of j-;mobile home ormaradacaued home.
Slgnbxe of ArEmr / - 1 Data signed(rata day,yead Ro
DISTRIBUTION:Oi0'urd-CamyAU®a,Fb8anped Cary•Taxpayer
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