Homestead_Auxier F't�- _ CLAIM FOR HOMESTEAD PROPERTY TAX FORM
" STANDARD/SUPPLEMENTAL DEDUCTION YEAR
Sara Form 5473(13171 1.16) HCIO
Prescribed by Vie Department of Lead Government pavrnta
INSTRUCTIONS'See reverse side fpdrmg instrucffw¢ U I(n
NOTE T- lc Social Sepaitp driver's Pcenm.state- and at +numbers em confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT -
claimed an the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded axitrad.
❑ 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 bust
❑ Am(are)the shareholder,partner,or member of the entity that owns the property.
. . .--_„- _. - - -
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Canty Toee i* Tans d9dd Rey,,est township)) -
Patel number cage deacteon Its ele popwly in guasfioc
❑Red pmpe y ❑Annually assessed meter Mar(tC 6-1.1-I)
best pato,d is re:Semis mumae or as best not tmeedag one(1)acre Mat irenedasly asians that stomas S used to prods iaars,describe the use end Carbon
orate property sized b prod=income.
.. &— I -I3- 04 - 000 S . (S 0-oa6 _
l cur : S ?- OPERTY.OWNEO ELELHERE DY,CLAhANT~ >ip t
T yi%:.7
Sea.Canty.and Toms ip Is claimant vacating a homestead?
❑ Yes ❑ No
*nature of �-
I hereby certify the oboe statements are tare,correct,and complete. X 2ait�t”
..1. el sated(raameaa+d sheet del,.and 2/Pm�) 40,117 rnadna er m�bdlvnasbat a curt(=iterate amatory.sate,and Hissed')
/OI Set... MA-,:n 'r' a. Z.
.r 'ASSESSOR USE ONLY _ ' - l ASSESSED VALUE.':'1•,HOMESTEAD VALUE;_,, ' NOII-RESIDENTIALLY -2.
:"VALUE
Land not exceeding one(1)acre immediately ?, (Yf tp 4
sounding residential improvements t) _: T rrsc,.
Other land (2) • ....F -Gk. t.
Total land Dine 1 plus line 2) (3)
Residential ial Improvements or Owe6ing (4) Fly:.- 3 ',
annually assessed mobile 1 -`;
manufactured home Garage (5) s *.
ss . ; t C-vw) :
Other im provements (6) _r_-e_d,_-< .-'=.r-.'E Er 8 21117
Total improvements(line 4 through line 6) (7)
Total value (line 3 pis line 7) (e)
I hereby certify the above is true,correct, Signature oAssessar
and complete.
Vattie action.SWiatse oA.lbr (aIBSnN COUNTY' rmdb,dig Inn
i - p . ?_•ST:JIDARD•DEDUCTIONALLOWANCE yam_ -r r sin i`:_4
20 pay 20 Lesser of 6096 of the assessed vane of the homestead or$45.00O.
NolsiCUtaMUg any other provision,the sum of the deductions porided in IC 6-1.1-12 to a mobile home S
that is not assessed as real property or a manufactured borne that is not assessed as nal property may
not exceed al(12)of the a of the whole home or manufactured home.
stature d g1.4..) Data signed(+lortll oar.
la -E-17
DIS RIBUnO,i:Original-cattyAa a,,,Fie- wen Croy-Ts:ayv
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