Homestead_Davis (2) a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
p. �.,x STANDARD/SUPPLEMENTAL DEDUCTION Fallen
State Form 5173(R17/I-1s) HC10
Prescribed Wine Depamm of tom Covensn=raze
INSTRUCTIONS:See reverse side for tag instrucfrons
NOTE Telephone,Social Segall);driver's Acenm,state Stratton and federal(dera'r7 n numbers me confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) .s!_„,1 ..�.. �/ .s -a— 4 certify that I(we)... . .. as T ('.. y' ':,? .
place of - ..-or am(are)buying the foaming desattled real property under contract for which a Homestead • ...- ax 'AFT-^^
Deduction is hereby claimed al the date this application is signed, (dale of SignaNre). I(We):
❑ Den. ❑ Am(are)buying under recorded contract MAY 9 2018
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a quafified p ' enc t
❑ Aril(are)the shareholder, partner,or member of the entity that owns the property. p,(
. • ' - ' ••-
-- - .. -
Cauay Taemt p Taxirp/QS-.bi`l(c(a."x town t cwarship) ('/s�`''�J� . . .
Panel master nLegal des:vane as 4 c VU to per.in //
IT IJ. lB-2 -8 J� nesiptcety ❑A. assessed=Ss hma(tC 61.1.7)
Rey porbm of the mtlaebal flinre a the land nal eraxdng ore(1)ace that Immc ataly wou,ds that sense is used to produce income,amrnm the use and portion
of the property oared to prodlm tmoe
a 0 1 t / 8 — `lot - coo. /3F - 00 7
ti.,ic s.. c"a:-.x R-.. PROPERTY,OWh E D ELSEWHERE,BY CLAI) ANinIiTJi$: vr- 1fl:t'?--1,. .
She,Carey,and To.rstip Is claimant vacating a homestead?
❑ Ye ❑ No
of claimant
I hereby certify the above statements are role,correct,and complete. l )`
-
Address dmnmd(number wcd street city,state and UPmit) vacated Leered,Rap(number turf street,rdy,state,and Weeds)
,y' /8 = Mal 0. 4 C' In
ASSESSOR USE ONLY It '" ,r,„1 • ASSESSED VALUE • J HOMESTEAD VALUE,:_A", t.O::RESIDEITIAL _ �_
° VALVE.: .
Land not exceeding one(1)acre immediately 3-s- - _ .
surrounding residential improvements (1) _,,r,:r...,_:S .!-i'- <-:r_5.,
Other land 3 .s:{ ::Si4F.:-:A�-T
Total land(line 1 plus line 4 (3)
Residential Improvements or 09001 C ,, �P -}-
annually assessed molds/ _`
manutactuted home Garage (5) c,la'� 1-10M1 ..
Other improvements (6) Yx_y o C s
Total improvements(fine 4 through line 6) (7)
Toni value (line 3 ohs line 7) (e)
I hereby certify the above is true,correct, Sign use dAsseasa Date signed(morn,day,was)
and complete.
Vaayig=on-SiVwaze okdbr this sigiel Orr*dal:year)
i'-Ia4T-747 rate L .c.- .STANDA RD DEDUCTION ALLOWANCE:a'r+44.yxs,f,'-..>,;yt.{C-ii ,t,-yy, 7c4r42 :
20 pay 20 Lesser of 93%of the assessed value of the homestead or$65.000.
Not tsta ndag any oth rprovision.the sum of the deductions provided in IC 6-1.1-12 to a mobile hone $
that is not assessed es reel property orb a manufactured hone that is not assessed as real popes may
not exceed one-la(1/2)of the assessed vane of the triable hone or mamAaWrtM home.
Solaro diodes /7 Date signed(aorta bey,yea)
06TWBtrnON:Cagtbe-Coney Mtea,Fismmpad Copy-Tespeye VV//..
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