Homestead_Gries (7) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r. `7 STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sax Form 5473(R17/1-16) HCIO
Presmbae Ey the Department or laol Govanoat Fiara
INSTRUCTIONS:See reverser for firing irst>uSOla
NOTE Tekplwne,Social Secu tilx divert Game,slate iierca5on end federal Werra: n numbers are confidential wider IC 6-1.1-12-37.
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CERTIFICATION STATEMENT
I edge) i"'I�'.`�a:�:31>•W4v t L Certify that](we)occupied as my(our)principal
place of residence or am(are)buying the following descnbed real property under contract fa which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(am)buying under recorded contract.
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the tout a the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the sha •holder,partner,or member of the entity that owns the property.
County Township Tak clinics(CA:totem,tarnish/p)
Pend mother Lena deso Ilsdn prvpaty in question
❑Real Froperty ❑Ann aay assessed noble tee(IC 6-1.1-7)
If any Mean at alt rasdenda store or me lark not esacL.g ore(1)ass tat invredately errant that severe is used to podrxe income,desama to use and port»
of Me property tared to;metre iaarme
a - d301- 300 - ooa. 51 L-&24.
r'C tam z C-71--.'ri`.."S,'r ',PROPETYrOWNED,ELSEVIH ERE',37f AIMAN¢ ,,172. -'17.2M
Sze,Carty.and Tennis Is daimant vacating a homestead?
0 Yes 0 No
Samara of claimant
I hereby ratify the above stateruents are true,elect and ootnplete. X I) „ _ A. �J
of mad(n.mtes street lab;sae,ac!Womb) X vacated rw�d�,eaa forma and selt.rrdr:stab,and ZIP cede)
4132 W 1200 3 Fkc.,,bstnd}Tiu '17431
;._ . 'ASSESSOR USE ONLY .t;,,..; 1 • ASSESSED VALUE HOMESTE DIALUE_ �- NON-RESIDENTIAL"'u
VALUE— I^e
Land exceeding one(I)acre hntnedktely (1) s "` h_i a1 $.�;4
surrounding residential improvements .+t- �s I s'
Other land 1 - i -
R) r
Total land(final plus tie 2) (3)
Residential improvements or Dwelling (4) - s tt'a, k_ c a
annually assessed mobile I
manufactured home Garage (S) < C ;.t 2 -
Other improvements (6) - l
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (e)
I hereby certify the above is true,correct BtXO of retread Dux signed(mtad;day,year)
and completa
vet-dying piece-Sgnatee at AUdb ChM sand(rrrZ%day,lea)
tray_; d±G+alte& ,.C: -. STANDARD DEDUCTION'ALLOINANCE'Sag e ° ,".1,
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
NdwU/slandh,g any other provision,the sum of the deductions Moulded in IC 6-1.1-12 to a mobile home E
that is not assessed a at property or to a rnam/kcaned home that Is not assessed as ma!property may
not exceed one-hat( the assessed value of the home ar manufactured home.
Signalise dander Rij Darn signed yea*/7
OISTRIe1JIpn:Drigtial-CasyAik3a,rte-Slurped Copy-To;®yer
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