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Homestead_Kirk �"- �. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR k: 1 STANDARD/SUPPLEMENTAL DEDUCTION y Fo `3; Sae Fam 5473(R1711-16) HOW Resulted b'de Department ot Local Government Fiance INSTRUCTIONS See reverse side for firing mstnlcLara NOTE Telephone,Soda'Seadi%divert Ecersse.date 6ienf5rabon and federal)de :caion numbers am coett,5al under IC 6.1.1-12-37. I(We) certify that I(we)occupied as my(our)•.,.'pal -(`Y�■ place of residence or am(are)buying the following described real property and contract for which a Homestead Property -...••yard Deduction is hereby claimed on the date this application is signed. (date of signab/-,Q =. �1 4. contract Own. ❑ Am(are)buying under recorded contra 1 lc�Q U Am(are)entitled to oc ipy as a tenant-stockholder of a cooperative housing corporation. w(4V y ❑ Have a beneficial interest in the fist or the right to occupy the property under the terms of a qualified personal residence trt+3L 1 •. � O�'(O ❑ Am(are)the shareholder, partner, or member of the entity that owns the property. 4 PJ .". Cant' Toerellp' Tang dada(lily;bus eerulip) iii - rc.Le4v Parcel ranter Lagd aawiptm Isf;41/perry a tea= J Red propemy ❑AUa•nay assured=tea Inca(IC 61.1-0 Nam gorden rite rarntal more or the land not easeing one(1)no sat inmedately surrounds and mumae b used to produce Inman,asaIDe the me and paten •de aoaeta uobed to produce teem a le - oa-°ci9 'O / oo o9/0 o/ 9 li t eG Z 1 *'-3t7..—P—ROERTYOvterg LSEWHERE art L'7,A'NT.i 7 "r.:::-'34 Sae,Cam,,end Teed© Is claimant vacating a homestead? . ❑ Yes ❑ No erpemer ,I hereby ur�tdy the above statements are clue,cortex,and complete. V w Address a=lad(nimiber aMSbast,dry,era.and Z/PCCY1 Miens vaceW1 nesead,eery(number and mw(cry,day,end Z/PSOd) • N - X. -F. • 2 inn" •ASSESSOR USE ONLY 2,- -(- 1 ASSESSED VALUE a := HOMESTEAD VALUe.-�' i T NON-V4LUENTIAL- LandotexceWing one(1)ere immediately 1 i ?=._rte s 'irr surrounding residential improvements ( 1 - {s.":_ -;.:?...74 Other land KL ...-" Total land(fine 1 plus fine 2) (3) Residential improvements or Dwelling (4) izt3:z s. r y.'*?:. annually assessed mobile/ a-< - ... manufactured home Garage (5) a--N "._ 4_w 4 Other improvements (6) :..,_e[v1[ I -?'`. Total improvements(line 4 timugh line 6) (7) Total value(Nne3 pits line 7) ON I hereby certify the above is hue,correct, Signature of Assessor ore Signal(rnayh thy year) and complete. Vadyg ado-%nature of AL Dam NaNd(milk th/.yen)•a ,... t•: . - STANDARD DEDUCTION ALLOVIANCE:,• -- - •- - .dd ., 20 pay 20 Lesser of 60%of the assessed vane of the homestead or$45,000. NoMetsfandi g raw Other pnmidon,the sum of the deductions provided hi IC 6-1.1-12 to a moMle home $ - thatfs not assessed as real property or to a manufactured forme that is not assessed as real pmpedy may rot exceed ale-hay(1/2)dffhe assessed vabie cfthe mobile home or nssmdacbaed home. Sete deed= Date shred(maa day-yea) ��jen,l, .t.�� / -/c0 -17 • OLtirRl0lmal:Orpmd-lszveyAui"a,FM�e9ad Cagy-Tamayw Page 1 of 2