Homestead_Page CLAIM FOR HOMESTEAD PROPERTY TAX !f ( '
'� STANDARD!SUPPLEMENTAL DEDUCTION •-•° -
r �: State Fain 5473 IFITH 1-16)
Aesmbedythe Depamaad LoirIGwanpnY Finance „ - ' I•I SIP". • •• NOS91'J
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INSTRf1CnONS:See reverse side huffing instructions. u- v .
NOTE Telephone,Sodal Sectnihs driver's kcerne,state idert6ra5on and federal klealicalion numbers are Gorrdurful • •- IC 6-1. - -37.
CERTIFICATION STATEMENT
• I(We) OIa#!lI«I!n__— --_ _...eignitts -- :P, . .. -.idtl.
place of : • • am(are)bldg the foaming desatbed real•.••- t •er contract for a Homestead Property Tax Standard
l`nDeduction is hereby claimed on the date this application is signed, (date of sign
lJ Am(are) entitled to occupy as❑a tenants-stockholder of a cooperative housing corporation. TEl
❑ Have a beneficial interest in the bust or the right to occupy the property under the terms of a qualified personal residence tort
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
- • - '
County Township Taxing dad t(ads awn ron5tep)
Rai maser tegd desaiptm s the p rope ty
�
�y• 1s—n- b1- `(Do - Ob,5 .H.D$-f5 a ( tC)ea n motes tome(cs.f.t-7)
eery mton Of are respend muses Or en land as moped%are(a)acre Intl mmadmeV saraacf that saemre is used to produce income,desatbe vie use and radon
at the property rd@ed to Probe None
Sate.may.an Towmhip Is claimant vacating a homestead?
❑ Yes ❑ No
I hereby certify the above statements are true,caret,and complete. ,?/:24t.&.....,
•
Address d w (,xnteas(sweet city.Safe. ZIP axle) d tmoaad,nary(minter end meealZ�um)
7 ' l-ford' in. �ivensv;11eTN_. 17665
- -ASSESSOR USE ONLY. •_ _.. - ASSESSED VALUE;c c` HOMESTEAD VALUE - yNON-RESIDENTIAL ''5-r.
VALVE
Land not exceeding one(1)acre 4etnadiatay
surrounding rreslde rrtiN improvements (1) :Fir_.-..,-.—ie`�•'..
: ..:-.•-t*.$
-
Other land (2) ` 1
Tote)land(line I plus line 2) (3)
Residential improvements or Dweing (4) s rays ,.t 1
annually assessed mobile I - ":
manufactured home Garage (5) _ .s'`✓: ..° . e •i,+s
(6) 'E`:.r i
Other Improvements x,);x. L-:“: .::..x.-„sg»_
Total improvements(line 4 through time 6) (7)
Total value (line 3 pits line 7) (a)
I hereby certify the above is true,correct. Syw-ve OfASSessa Date sired(row=day,year)
and complete.
Vaeyig acorn-Signature aAudbr • ` • ad dfi:Yee)
- 08819
_ aair,.s.. t• .•y ”. _ STANDARD DEDUCTION ALLOWANCE: Saar'Y, En -s 'C•is/,4,
20,,.......,,, pay 20,.,,, ,.,. Lesser of 60%of the assessed vane of the homestead or$45,000. r� Q Q,�
NoMfMstarlddrg any other proton,the sumof the deductions presided,m IC 6-1.1-12 to a mobile home S API'PIAZ ZB1EtidV
thefts not assessed as real properly or to a manufactured hone that is not assessed as real property may
not exceed are-ha/(U4 of the assessed value of the ruble home ornramdaamM home.
SgraNaNNidbr Elate S•.... Wee ,
DISTRIBUTION:aim-Dusty arfax,ResanpedCeoy.ToVeer GIBSON •S , - -r• .
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