HomeMy WebLinkAboutHomestead_Hogg ,f^ '.,., CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
F may,,k. STANDARD/SUPPLEMENTAL DEDUCTION FORM
S' Stab Fam 5473(R17/1-16) HOW ,
Prescribed by the Department a Leal Government Finance
INSTRUCTIONS:See reverse side forfUOg instructions.
NOTE Telephone,Soda/Security driver's license,state idenf51a5on and federal£dent eaom mambas am confidernfid under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
' I(We) Si . _ At..s _ .• certify that I(we)owl•.':, :. m Pa
place of residence or am(are)buying the :m• ' _r••;-..•'bed real property dada contrail for which a • —. • ••2 ''' ,Tr:. •
Deduction is hereby claimed on the date this- is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract APR 1 S 201
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the bust a the right to occupy the property under the terms of a qualified - - .- •..
Qual personal '- ,.
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. ri JAi • viii
:
- • •
Casa Towshlp Taxing ddWV!(say,town ecemNp)
Peed mrnar Logal drag/barn the the property in quasi=
❑Real Pecan). ❑An aaey assessed noble hue(IC 61.14)
If any ports a me reddened sincere or tha lad nor exceedrat one(1)axe that immediately wands tlst wince is used to protium hue,de fame are use aid portion
dam papery uGrvxd to pct bea&
a Z l o - /d - / 8 — /03 — 00/ . a A9-o a. 8
r-.:.:77:-.7.7.--r-
fs _2 `PROPERTlOWNED ELSE:VHERE BY ClAIh1ANT ir '-e:' ,�'zy'
Sate,Coady,and Tpmahp Is claimant vacating a homestead?
❑ Yes 11 No •
v
I hereby..i• the above sfaternets are true, .•l• and compieX . t.`�.'.. - , a, •
ANY S ��• - �'
:/•� • • ,-••• - vaobtl hanesbad,lap(rxa++damf �:s3b,arxlZ .P 1
: ,� ASSESSOR USE ONLY ,•-.s � r ASSESSEDSA0 Ems.. i) HOMESTEAD VALUE..- „.-_. 1_RVACUENTIA�`
Land not exceeding one(1)erne Immediately 'stir r .a_c
surrounding residential bnprovernents (1) -'-& "+.a7 ;l ,: '
Odor land (2) ,_. ..,_0).'.,..7u X2~.,5:':
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) i :s -1,1 .t.r
annually assessed mobile I - r e-_;"s:
manufactured home Garage (5) ,. s:.<._ .::=-.uwr-'14/?:m
Other Improvements (6) -,- Q(N
Total improvements(line 4 through line 6) in
Total value (line 3 piss Pure 7) (6)
I hereby certify the above is true,correct S atusessor Dab signed(moan dry,teal
and complete.
tie flg arson-Signature of AA6b Dab signed(mon day,year)
20_pay 20 Lesser of 60%of the assessed wive of the homestead or$45.00D.
NohslUs bane g any otherprovision,the sum of the deductions provided N IC 6-1.1-12 to a mobile home S
that Is not assessed as real property or to a manutamued home that is not assessed as ma/property may
not exxcceee/dd one-hat(11Rf)of the assessed value of the mobile home or mamiachaed home.
Sigahr ti�/ _ i'/l //e
J / Daze signed(notch.day,Yaw)
DISTRIBUTION:ORe-Stamped :
al-Coady Aortior Re-Stamped Copy-T `graye
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