Homestead_Nichols ;c.i.f.., CLAIM FOR HOMESTEAD PROPERTY TAX a oREe YEAR
•1? i STANDARD/SUPPLEMENTAL DEDUCTION
Sire Form 5473(R17/1-16) HCIO
Resmbed by the Department of Loci Goverment Flame
INSTRUCTIONS See memo side for Ong ersaudara.
NOTE Tdageone Social Seaail)t drivers Ecease,state ata:on and federal l.t atiom numbers are oonhderdial wider IC 6-1.1-12-37.
CERTIFICATION STATEMENT '- • •
I(We) lvr • .�. .. :- _ •�.
place of residence a am(are)• •the following desalbed real property under contract forrrywtlich a Horn.-, .••'..,.:' tT. '� rd
Deduction is hereby Winged on the date this application is signed, (date of sig(nature)•I(We):
❑ O.M. ❑ Am(are)buying under recorded contract. DEC 2 2 2017
❑ Am(are) entitled to lmlpy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the test or the right to occupy the property under the terms of a • •• - - •r-, =- • - ..-
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. e
-It
-` - • .\
- _
County Tosahq Tamp district(oly,Mat romaNp)
PaW meter Portly bR 5. 1
-C y0 fr Ira aLSJW prape+b ❑Amos%assessed motile roma NC 6-1.1-I) NJ
It any man a the residential strumre or as land not eoeed.-p one(1)acre pal IwnedaaN mammals r*(tlalaava t.used b produce Nome,desate 4s Lae and portion
a Me properly oared b aodsa comae
•z6 f2 _ o7 _ &o 3 - oo3. 3 y7-o )- R
Y:AeQ '. .s-z<� _PROPERTYOWNED.ELSEWHERE 3-Y.CLAIMAVT '�L - :`Tr. - .,,.,ftT' 'N
Sras•Casey,aid Te/re*p Is claimant vacating a homestead?
❑ Teo ❑ No
a
I hereby costly the above statements are true,Linea,and complete. �� Iµ ti r� `•1 1.1 c l�
Addeo oframd(rmiPaa.d beet dhc see.end Work) Adders a`^_-`..-•Irprm+L dssrf(mamhevemslstma.dh:sae.and ZlPcodt)
3c �.��� y1ro7o
ASSESSOR USE ONLY < o -__ ASSESSED VALUE'.::;-' 1-HOMESTEAD VALUE. .1 _ NO tt RESIIDENTIAL -
Lend not exceeding one(1)acre immediately (1) .•u'�4 _-
sunwndmg residential improvements . _. .-.
Other land (2) t:-'r=L��+:iu=f5'r.':�:t....
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) - 2• r
annually assessed mobile l -,.
manufactured home Garage (5) _w" 'ti
Other improvements (6) M^-gd`.'».���`.-'31-': g
Total improvements(line 4 through fine 6) (7)
Total valuo (mm 3 phs fare 7) (6)
I hereby certify the above is true,correct, Signe.ae aAssessar Oats signed(eEd4 day yea)
and complete.
yeas.;armors-SbaGae aAUda Dab signed(me4 day.leal
" y.`..... -,_. -..RSTANDA RDDEDUCTION ALLOWANCE'(? -' .. - .t.,-.
20 pay 20 Lesser of 60%of the assessed vane of the homestead or$45.000.
Nanitheandng any other prov :Me the sun of the deductions provided in IC 6-1.1-12 to a made home $ -
that is not assessed as meal property or to a manufactured home that is not assessed as real marry may
rot reseed anedaj(V2)ofthe assessed value of the made home or rnanufaciumd bore.
Signalise Audi \ ,(A _ �� Q_ Data signed(mat.thy,year)
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Dunarol-Coam•Az ,fie- reed Copy-Taxpayer
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