Homestead_Knott -- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD!SUPPLEMENTAL DEDUCTION FORM
t-' Sax Form S473(R17/1-l5)
fYmmLm 4 to Departmental Loaf Government finance H010
INSTRUCTIONS:See reverse side forting rutrudnrs.
NOTE Telephone,Soda/Secuebt divers Fcense,state idertharadon and fede al tours i5cc�a+ffen raanters are confidential aderIC 6-1.1-12-37.
I(We) S ea-y / Z /7,- t 1 certify that t(we)occupied as my((QQ I
place of residence or am(are)affirm the foaming desmbed real property under contract for which a Homestead Property l �,1
Deduction is hereby damned co the date this application is signed. (date ofsignatlre).�a(,e): /
❑ Am(are)buying under recorded contract. c
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. Fa3 1 6 2018
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal residence
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
.
Cote4' To retlp Ta hig dsniC twwnbev6h4) / .
Petra r.n Legal dasop:an b� — LAN lacer_
property F mastic¢
aill Reel property ❑Amtaey massed metes home(IC 641-?)
If any pagan d the residential seumse ate lad not exceeding one(1)acre ast thnedtely saraat5 tlst=can is used to prance antra climate the tae and portion
or to property taxed to prore:aana.
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- � .. k�' -,..„:. .`�?ROP.ERTY.OWNED.ELSE:'JHERE BYtCLAIh'ANT r''. . ,�r?a: _" ??'7,,t,`w'
Sza.Casty,aid Township Is claimant vacating a homestead?
I hereby certify the above statements are true,coned,and complete. at(I / . X12 f
Address of anxcl(,wrYeerea/street.city,state..7and Dpml') �7 / AdAmssaal vacated deny edspew,efy,slab,w zwaa)
/ 697- 3, s �/. G<��Gn b(i r/
r..-•ASSESSOR USE ONLY I •ASSESSED VALUE -t� HOMESTEAD VALUE A,I ,HON!V4SIIDENTIAc:
Land not exceeding one(1)aere Immediately
surrame:likgmsidenlalimprovements (1) Y2P3 i - 0
Other land (2) l- 1t -.. ,+.__
Total land(line 1 plus line 21 (3)
Residential Improvements or Dwelling } `..
annually assessed mobibl (4) i"-., Lrt N.S `�'€:.S
manufactured home Garage (5) ? x i a yr> ^%:s, ytaw3
T •Oman improvements (6) a _� ' ,
Total Improvements(line 4 through line 6) (T)
Total value(the 3 phs(ate 7) (6)
I hereby certify the above is true,correct, Sig-Gyre of Assessor Date silted(=ran day,year)
and complete.
%flying arson-Sigaere afudbr Ike signed Main day.yes)
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--.a7y-X.77 r-STANDARD DE DUCTIDtd ALLOWANCE... - - ---7 ' `Fr-n7--4
20_pay 20 Lesser of%%of the assessed value d the homestead or$45.000.
Rotw:hstandvig any other provision,the wall of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real properly orb a manufactured home titans not assessed as tai property may
in exceed one-hat OM of the assessed value of the rebate home or man taMmN home.
Signature of Dale aped(than day,yeah
D1SMIEIL iON:Origosl-Casty Anded.Rie-Samped CaVy-Tagafe
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