Homestead_Miller in-r;; CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t�NA STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sate Form 5473(AM I-15) NCI
Pureed by ere Department S Leal Govailment rerats
INSTRUCTIONS See reverse side Ip66ng h,stumms 1 ; g
NOTE Telephone,Sodal Seauii%diver's Ecense,state idenfi3ratbn and Federal Nar4rica5on saunters are confidential under IC 6-1.1-12- i 1 6F1)
�� CERTIFICATION STATEMENT -. E r •
,f.,,,..) .�` 'F.' • i . ._.•l/R!JI'I1,�J: certify that I(we)occupied as my(our)principal
place of residence I am(are)buying the following•,>. .!real property under contract for which a Homestead Property Ta1J
.�/�/,��11_ucti1rom'is hereby dammed m the date this application is signed, (date of signature). 1(We): — 1 2017
0 Ow,,. ❑ Am(am)buying under recorded ve housing❑ Ann(are) entitled to occupy as a tenant-stockholder of a cooperative housing carporatim. .iii;
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pe1� i owns P" j�Fl7 V AUDITOR■❑ Am(are)the shareholder, partner,or member of the entity that os the property.
-. - ,
, - - -
Canty Toesm, Taxing amid(rt) tan roe 6
Peas)at Lead desa*l 2 I Is ad Pnpey in mestiaa .
❑Red property ❑warmly assessed mods epee(IC 61.1-i)
It any Patin at ae reddened mare or the land not aceactip one(0 sae that summarily/surmises ant nurture is used to proaree acorns,desate en Me ad ration
a the properly tared to Wodxeomve
acs -n -o1 - 4o3 -C903-- Col : -Oa
.„,,,;,„=„...;--77.7.,:.-7.;::::::-;(rr r, �:PROPERTY,OVlNED,ELSEVfHEREBY,CL'AIMANT - -=;"_-sue'+.47.64 .941-7"...77t
Sate See Couny,ad Tamable Is claimant vacating a homestead?
/❑ Yes ❑ No
I hereby certify the above statements are true,correct and complete.
.+at contact(nuareranl meet my,gee.rid Wade) AdSenS -....c. -. itany fls„ar.ndabwr.rCl:xre and2lPmM)
19CM t,✓ ,U r-J'h S / MYS(1 'lei:-.e-,- .
ASSESSOR USE OfILY - _ 'ASSESSED VALUE ' :A•r HOMESTEAD VALUE ''' .14011-RESIDENTIAL - ri
.a - J - "I - VALUE-- c-.' r
Land not exceeding one(1)acre Immediately y--.."cr-
surrounding residential improvements (t) rd„k'-+-r„ 1 'i
3 'E r :c
Other land (2) - _ e .<ila-.�-:_„•'.l)
Total land Rine 1 plus line 2) (3)
Residential impnimanents or bvdanY (4) 1..- 7 a x'-tir
_ _iti-1: "T. p
annually assessed mobile
I
manufactured borne Garage (: .n_
Otherbnprovemenb (6) „r1.3k'' » ;7._liN
Tod,Improvements(lb,.4 through fine 6) CO
Total value(line 3 phs linen (6)
I hereby certify the above is true,correct.
Signature of Assessor signed(morr/t day,year
and complete.
Veiyag acacia-Sia :Ise of Audis Data sired(=WA day lea,)
a ',v'-d - +.;STAWDARDDEpl1QTIOF:ALLOYJANCE s
20 pay 20 Lesser of 60%of the assessed true of the homestead or$45.000
NotelitatincOng any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home $
that is not assessed as real properly or to a mantdactw d hone that is not assessed as real properly may
rut exceed (1/q of the assessed vans of the mobile home or manufactured borne.
Swain or
0STMESI llOV:Original CoutyAi s.FeeSanpod Copy-Tapeye
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