Homestead_Harbison v -V
3-. CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
r ....�„•
STANDARD/SUPPLEMENTAL DEDUCTION FORM
-�,3�� S2ta Pam 5473(R17/1-15) HC10
V•t, fl Presci6ed by the Departs at Load Government Finance
INSTRUCTIONS:See mwrse side for grog instuc6Urs
NOTE:Telephone.Sodal Seaai drivel's tense.stab idenfi5cagon and federal irle affou numbers am carsfdenfaf underIC 6-1.1-12-37. '
/� CERTIFICATION STATEMENT r ` J
I OW s ac-) cendy that I Moe)ocnsPred a my(era)P^nci•
place of - !-or am(am)buying the farming described real property under contract for which a Homestead Property Tax ward
�`,,D��e//ducion' .. claimed on the date this appdxation is signed, (data of*insane). I(WeyH f g
yq Ann ❑ Am(am)buying under recorded contract J ?p/8
/❑ (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. G49
❑ Have a beneficial interest In the bust or the right to occupy the property under the terms of a qualified pelsa al
❑ Am (are)the shareholder, partner,or member of the entity that owns the property. O
�yAir
I/.t,. 4 e
Legal desaipoar t apsmc
dReyproPady ❑ .--_.moErabse(IC6/.1-7J
It of ore razperGal seumre cc Malana not enamor au(1)ace to toned ely- • --Our arose is used m prddtae- ..... amaze the tae and panto
d Maned to rase tram
a-/9 /9 /O a+
-, _. - -":)f-:.a.::'-�pftOPERTY,OYJh'ED ELSEWHERE BY,CLAIMAtdT.(' "Y _ --4J,-,.=y'-is
Ste.Camay.at Township Is caiman vacating a homestead?
❑ Yea ❑ No
deinad
I hereby certify the above statements are true,correct,and complete.
Adzes d rand(antrmrl.shad.city.C are,and 2JPccde) ( of sainted homestead.if any Wnter an!abeet o3:sate.W ZIPccde)
2.a w�jtVLVStte s ostAfroci 660
`ASSESSOR USE ONLY 4 ASSESSED VALUE ;-HOMESTEAD VALUE ` ...._ �.OfJ-RESIDENTIAL}��'_=
VALUE.. '1
Land not exceeding one(1)acre hnmediat*h ?'7-2 f t^ ---summating residential improvements (I)
w tg,:em_ `?s._ ?,ti
Other land R) ?... ..st Fee. �• -«
Total land(line 1 plus lire 2) (3)
Residential improvements or Dwelling (4) ; 'C•: k x.._`-
annually assessed mobile l 't' y
7 .'
manufactured home Wage (5) '-y5-^''-._.45s:;.tv'--i±''
-Other improvement) (6) s3.; . 1Z A
Total improvements(fine 4 through lime 6) (7)
Total value (line 3 plus fife 7) (6)
I hereby certify the above b true,correct, SIW-'°°ofAasass r Drs sated(CnIt' may,y*a)
and complete.
Vetytg action-Signature of&dtor Date Signed(rWriU;day,wan
'�`-' :- -:�.STANDARDOEDUCTIONACLOY/ANCE4- - -! 7,.:fir'
20_pay 20 Lesser of 60%of the assessed vdue of the homestead or$45.000.
Notwithstanding arty other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property ore a manufacaued home that is not assessed as mat property may
not exceed woe-half(1ln,of the assessed value of the nmbde home ormantdacuued home.
Sgnmse elkrdtx Date sinned(nor*dey,leas)
DISTRIBUTION:Origiel•CaaeyAURa.Ft)-Stanpad Capy-Tamale
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