Homestead_GrabertI
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
e STANDARD/SUPPLEMENTAL DEDUCTION
{ '- Sass Fan 5473(R1711-16) HCWO
+� Prescribed by the OepaNreR or Lace Government Fiwxa
INSTRUCTIONS:See'everse side for firm msbW'ons
NOTE Teephone,Sodal Security drivers ecarse.state idereraton and federal lderex,'abon numbers are confidential under IC 6.1.1-12-37. .(�� •)
CERTIFICATION STATEMENT
/
Me) '—��r :�f/�1'�/1, certify that I(we)occupied as mss(our)pmlcivai 1 9 2017
place of -ss....��rrrg.1��1+''1!J'.;cs am(are)buying the louo img described real property under contact for which a Homestead Property Tax 5'�and
b.. ,.'hereby(limed on the date this application's signed, (date of slgnatu ). I(VJ . • -
• ❑ Arr1(are)buying under cooperative housing corporation- /@SO/�C
` ❑ Am(are)entitled to omtpy as a tenant-stockholder of a �U/1,T
❑ Have a beneficial interest in the trust or the right to occupy the property under the ten's of a qualified personal residence trust. AUDITOR
❑ Am(are)the shareholder,partner,or member of the entity that owns the property.
PaaJnmba
i
\Ni- —
v/✓C�. ,: •, - , -
// . Red lnaly ❑A_.. assessed mote home(ICSr.t_n J
adn./ a re5d produce harm.a oa and na-S <ae(1)••..,• �/� atnxBaaulammptod�:vvmA amrnm ve w.am portion
BY,CCAIAIACTa. ,z 7 .-. ...' � ;_aukt-' `.
6m.Cony,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
a
I hereby certify the above statements are true,correct and complete.
address a aroma(manhattans meet stab.aid Wade) 1 a hawstal,irony venter we - .gee,end ZIPcade)
3311 ' Licit I7r f0Larl- Ors
'ASSESSOR USE ONLY ASSESSED VALUE'}:..i iHOC1ESTE D ALOE'_. 'HON RESIDENTIAL=r"+
a� �•:` ( ?..`{ '� VALUE -`=
J Land Trot exceeding ooe(1)acre hlmsediately h�; - -
surnoimdlnp residential mioroyemerlb 0) rt1` + -,s;_p.
)I Other land (2) "#e 4 02
r1/499,b'
V� �j('y��%' 1 total land(line l plus line 2) (3)
Residential Improvements or Dwelling (4) s-4
annual c assessed mobile I
'11j1'111•� manutacbsred home Game (5) �. z 1- °",
ONer lmprbvemenb (6) 'xc' t -i a`.
Total lmpmvemenb(fare 4 through line 6) (7)
X1/ Tool value (litre 3phs line 7) (6)
I hereby certify the above is true,correct, 6lgnanm of Assessor Dxs signed(marl;dm:year)
and complete.
verifying arson-Scram of/raft'. Offi signal(a:,nk daS yea)
-" `— - i r_STANDARD,DEDUCTIOk'ALLOWANCE; ','d. r _Y>_
20 pay 20 Lasser at 60%of the assessed wive of the homestead or$45,000. .- -
Nohiarstancfvg any Other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that Is nor assessed as real property may
not exceed one-half(U2)of the assessed value tithe=bee home or manufactured home.
5ip+agm aaad'ar Dare nipped(math dsY.fear)
051R®frON:Original-County Auia,Reu'mped Copy-Ta paya
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