Homestead_Shanks i
CLAIM FOR HOMESTEAD PROPERTY TAX
�rr'+ FORM YEAR
I� �,; STANDARD/SUPPLEMENTAL DEDUCTION
State Form S473(R17/1-16) HCIO
Ftesclhed by ore Department or Lord Gown-mem Finance
INSTRUCTIONS:See reverie side]orfUng h bvcffons. t
NOTE Telephone,Soda/Secraf4c threes license,state ideracaron and federalldertltcab'on numbers are confdential • ! :i.1 •-37. :
CERTIFICATION STATEMENT
. I MO W!`!!�_sa lL 1 Ifit!i!lit- Certify that I(we)oavgedr rt y(or*q�o�7rv�F��2I�
place of residence: =Ware)buying the following descnbed real property under contract for wt which a Homeslea psity ffiz J`a�rldard
Deduction a hereby claimed on the date this appiwtion is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract.
alemar
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the that or the right to occupy the property undo the terms of a qtasistypepOutifeRe Bdd0l1 OR
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
- '
.
be
Ca Tomerdp Teem 6sat(ray. tranship)
n
•
Parcel curter Legal description its the popery F CILeStat
❑Red awerty ❑Arni my assessed mottle lore(IC 61.1-7)
Ural porton of die r0»krauts or Me land na courecho ao(1)acre that inmate*sounds that annum is used to padre non,describe the use an potion
of to properly utlaa in Pradsa'scom.
(96 - 3 -14- 1400 — 00t. (031- DO
_".7.2::,-, .. :cc .;,.e' S_-; ';3:-.:�SPROPERTY OWNED;ELSEyWHERE:BY.CLAIAMANTAlarn err ic-._'�,9�,. 7i :. `_it
Sate,Casty,and Township Is dahnant vacating a homestead?
❑ Yes ❑ No
Strata*or dolman
I hereby certify the above statements are true,correct,and complete. ��►/(, -
.-._- -.cared(nntrarn stye(arc sae..and BP=de) �r�J/�Addesl of mad homestead.dye bsndrardbees,M:Sale,end LPSxb)
r • aSSO . 6 . -, --ci 4? .
7-lc--;- S :r. ; vanOMEST NON;RESIUENTIAL''.Y'
-v ASSESSOR USE ONLY t_..., ' ASSESSED VALUE .I HOMESTEAD VALUE:: n'.' VALUE_
Land not exceeding one(1)acre immediately ji 1;
surrounding residinnal bnp vemenb (1) ▪ az t t ,?
-
Oder land (2) _
,. [i:a%f-$_.-
Total land pule I plus tins 2) (3)
Residential Improvements m Deeming (4) -▪4f-- _
annually assessed mobile/ _ _-?---_-_ _-_Eis'�'•_t.:;_-.s
i :-T
manufactured borne Garage (5) E.._.i
Other improvements (6) 4 >..rr.;- -a:
-iF'�N 0.r_in,-'_'".:-- _
Total improvements Vine 4 through fine 6) (7)
Total value (line 3 phs line 7) (e)
I hereby certify the above is true,correct, S. the°]Asses° Oar signed(north.my,year)
and complete.
Veayig action-Signets.of Amor Dab signed(nordh day.yeah
a- _ L' z, m-_;STANOARDDEDUCTIONALLOVlAr4CE - ,_ ..r .. v_:. . ..'N..Y-.
20 pay 20 Lesser of 6096 of the assessed value d the homestead a§45,000.
NohWthstaM,g any other provision,the sum of the deductions provided In IC 64.1-12 b a mottle home § •
that is not asse as Teat properly or to a manufactured home that is not assessed as real property may
rot exceed (1/4 of the assesseof the mobile home or nsnz cued hone.
brewed Nadler •:Original-CareyAe9a,rte-Slareed Copy-Tensaw
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