Homestead_Sollman ,-e■ „ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R17/1-16) HC10
Prescribed try m Department of Lobe Govumine Fence
INSTRUCTIONS:See reverse sit*Mr tang instructions /
NOTE Telephone,Soda!Seca*driers base,stets identdcaton and federal ldenr03ca6on numbers are con3derttial under IC 6-1.1-12-37. I
CERTIFICATION STATEtM ENT- ,y
I Mle) //i/i///!/ Ii/ /i. .• / 1 //,t certify 0¢t I(we)occupied as my(our --"-4
place of residence or am(are)buying the framing described real property under contract for which a Homestead Property Tax ,v
Deduction is hereby claimed an the date this app ortion is signed, (date of signature). I/1 ): 7 20
❑ Own. ❑ Am(are)buying under
cc ing uer recorded contract 6 I - • f8
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. `SAN Ch
❑ Have a beneficial interest in the trust or the right to occupy the property under the gnus of a qualified personal resdet- Ts7 vi
❑ Am (are)the shareholder• partner, or member of the entity that owns the property. ) 9
/'
: - • -
Tormstilp
Stan rsvmr _. /�/ ,.
-•- - ._,.• I� -, assessed rmNa hma(IC6-1.1-7)
al. 1..j. a nrerest m moue or Ms laid • eme&V a*i :.Via . 6fsl sWLaa is reef m. urama,desWbe a and paean
spry_
01� -/7-011 -/6"o -06/. -0o-/ %.5. 33 -
Q __ . _
Ia 2
• I .�.--°�?,;': ?fcf.:Y�,P,ROPERTYOWNED ELSEw/HERE(RYLCEA1hiANTtS r"Y.n7C777a-M^
Sam.Carol.and Toslstp Is claimant vacating a homestead?
s 1 A ❑ Yee ❑ No
�(/ I hereby certify the above esstate Iments are true,correct.and complete. ). - / y- 4L
(,� 600 �c V)t•I.aba4l zi11 LIs�(/L(,lt"p� ,.•a (/rsy '/•1•tr.maa•/araaGew.ob:sta.end ZIP code)
•
4 n ,ASSESSOR USE,ONLY ;1 .- ) ASSESSED VALUE: HOMESTEAD VALUE '._ `�-? N0:1-RESII
VALUE NTIA rl
Land not exceeding one(1)sue Immediately
surrounding residential improvements (1)
-c..__.
Other land (2) s'{j
Total land(line I plus Una 2) (3)
annually assessed or Dvremng (p)
annually assessed mobile/ -
manufactured home Garage (5)
Other Improvements (6)
Total Improvements(line 4 through line 6) (T)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct, 54'aace olASSessa Dee sigma(nxrrtt rive lea)
and complete.
VuiS+d slim-Signalise oAults Dam Urea(677^601.66Y.).64
:' - STANDARDDEOUCTIOid ALLOWANCE. -:•� �.ey+�...%. �F' �.;•�i-:
20 pay 20 Lesser of 60%of the assessed value of the homestead or 50.5.000.
Notermstending any other provision,the sum of the deductions provided in IC 6.1.1-12 to a mobile home S
that is not assessed as real poperty or to a Manufactured home that is not assessed as real properly may
rut exceed one-hal(1/f)of the assessed value of the motels horror orrtbodarhnpd home.
Waive dAUEev Dm signed(meta MIX,yam)
DISTRIBUTOR:Original-Cash AuCa,Fie-Stmmtl Copy-Taxpayer
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