Homestead_Stevens Jr CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FOB --
Slate Faro 5473(R17/1-16) HOW
2Y' Reacted by 9e Department of Loral OwaminY Rwce
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INSTRUCTIONS See reverse side forging nsbur5ons
NOTE:Telephone,Social Slang)'ddwwS kens&slate idertff5calon and federal identicaffon numbers are smard¢I coder IC 6-1.1-12-37.
CERTIFICATION STATEMENT
• I(We) 4-- ce ' rl U Si place of residence or-. (are)buying the following destnbed real • under contract to which a - •It•; 'T- I:
(eduction is hereby claimed on the date this apprltaion is signed, (date of signature). I(We:
❑ Own ❑ Am(are)buying under recoiled contract DEC d 2,2017
❑ Am(are)entitled to tJC spy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the test or the tight to occupy the property under the terms of a quarifi-• personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. a
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Canty Teeret Tata district(at%!MT,berslap)
s1 T
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Parcel n r a thgS mso;em 1 .05 A c I le alePro Pe ^
ha 3 /o-oz- / /
Pwaty ❑A+oamY earned=Oda tm.(1Cs-ti-71
•an'pmrmn d lee re ells rmmaea ere lad as acceding ore(s)tae that immeadely strands tat mice is used as Potts bomb defame to use aid pagan
of to property mixed b prodrn'vaeme.
02& I1 - 3( - .zoo -, boo . 5/ 3 -ogz7
A`ta.•_r- ,' -r .'PRIAERTYOWVED ELEWH:'HEREBY,CI'AIh1AtJ-'T "',i { Y,;,"+_-p •-,.
Sera,Candy,and Taaship Is claimant vacating ahaanestead? -.
(�, ❑ TOO ❑ No
`J ddaanae ` C
I hereby certify the above statements are true,nxtect,and complefeX
Addass daxdad(mmder at abeet ale able,and ZIP Atria of ilia_James deny(anderan street My,sale,at ZPwc6)
Un,-F cR.'f0 r 1-9,-113 5o 5p r4N 4l7coib
ASSESSOR USE ONLY _ t e ASSESSED VALUE . .4 HOMESTEAD VALUE I NOG_RESIDENTIAL
. °-Lend not not exceeding one(1)ace Immediately
suaoun mg residential improvements 1) C.r r_ 'i+
4
Other land (2)
Total land(line 1 plus lee 2)
Residential Improvements or Dwelling (4) l TaX2--t g
annuaDy assessed mobile/ I{ �, } - ,i
menufxhzed home Garage (5) iz3z
Other improvement (6)
Total improvements(Ime 4 through line 6) (7)
Total value(tine 3 plus Tune 7) (8)
I hereby certify the above is true,correct
Signature of Assessor Data speed(covet eat geed
and complete.
*drying salon-Sgnatra of Ambit Data signed Ora day,yet)
..,. - �s 'ri.�"'_ �. --. . $TAFJ DARDOEouc noNALLOI'JANOE.::,+s+'•� .>.ir ~ ,. ..
20_pay 20 Lesser of 60%of the assessed vane of the homestead or$45.®0.
No&dhtsxlg any Other provision,the son of the deductions provided in IC 61.1-12 to a mobile home $ •
that is not assessed as real property ore a manufactned home that is not assessed as real pmpe,y may
not exceed one-ha(1/Z ofMe assessed vabe of the mobile horns or maredarhued home.
Sptere et Nate / Wee aged(attn.day)e)
DRSlWBtrnON:Original-CautyAUdda.Ro-Stamporl COPY-Tarpaya
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Address of contact(number and street city,state.and ZIP code)
36485.SOW P;n - -n -z1 Z/7(e7o v.
NON-RESIDENTIAL
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE VALUE
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�S Qtn '4'0 °�'�
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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