Homestead_Tepe ‘:. -,... CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
...s_ r‘c.(':::•;' STANDARD/SUPPLEMENTAL DEDUCTION FORM
tAI:*. Slate Form 5473(RI7/MO
14010
Prescribed by the Department of Local Gcmarrstent Fele=
INSTRUCTIONS:See reverse side for firing instruthons.
NOTE Telephone,Soda!Searrifx driver's&cense,data iden55tur5on and fades!Iderstfficafion numbers are confidenlial under IC 6-1.1-12-37.
I(We) certify that I(we)occupied as my(Ott)principal
place of residence a-am(are)buying the • desaibed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
Own. 0 Am(are)busing under recorded contract
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal residence trust
El Mn(are)the shareholdec partner,or member of the entity that owns the property.
-, - • •.'
Canty Teems/is Taxing&Aria(ay,loom,fornsfip)
Patel neater 189ainascripton Is the properly in question
0 Red Falser/ 0 Antony assessed amble name(IC 6-1.1-7)
If am partial Cl the residential stricture cr Ihe land not ecceedms one(1)eae tat immedialeig surnames last sbuClise is used to produce Scans desalts the me and paten
of the property utitred to produce income.
o5 t-op 1
,..„,..s„,.:..,..4aCrarg7aliala&-far-tOROPERTTOVINED EtiEtt/HERErCLAIIA ANTS: -4:-.-Ii.....44,4,-Tirt-74.•=T..-"--.'.•te
State.Gassy,aid TaanShip Is claimant vacating a homestead?
0 Yes U No
of dahtstt
I hereby certify the above statements are true,oared.and complete.
C-ty k._
Address Cl screed(xamterand street city,a and ZIP cock) hanesteect.d (renter end ,state,end ZOficed0
* (Q6-a- & 1300 5 E 0 - 1 1 _c, 0
.
-_.:.-ASSESSOR USE ONLY .''.Ai'• •-.--1 t• ' -ASSESSECVALUE -I• A HOMESTEAD VALUE.e-i;- - b-
Land not exceeclIng one(1)acte Irrumediately ci:••-'itWrte': 2-W2i1;-_-,(7.-±,2_7.--Iii.atIg.ft
surnsunding residential Improvements (1) --"_: •.:2v1.-t.:4C4V..-HAYsiiii.Hearitt.;::Vi;
Other land (2)
Total land(line I plus tine 2) (3)
Residential Improvements or E Dwelling (4)
enough/assessed mobile/
:`,illsiTiTiti.A2:721.i.ttf-;;ATifirArIalfiii0r;
manufactured home wage (5) Ieii-..--aeA,'-..27 CeTs•f-;Tet.'....-e.e,t4
Other improvements (6) gi- r1; PR2Ir-/RIrk!".5
Total Improvements Pie•through line 6) (7)
Total value(line 3 pits line 7) (6)
Signatire otMsessa Dab signed(goat;day,year)
I hereby certify the above is true,correct,
and complete.
' dying salon-Sign-rare of Audbar - Data signed(man,thy.yew)
20 pay 20 Lesser of 6046 at the assessed vatt of the homestead or 745.000.
Nohbithstancting any other provision,the sum of the deductions provi*d in IC 61.1-12 to a mobile home $
that IS not;-v soad as real MOM:Cy or to a &attired home that is not assessed as real omPellY may
not exceed•; at(132)of the assessed v of the=bile home or ManlitaCtilted home.
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cisrmeurroNt°done-Carey Az ,Fie-SlarkEed Cy-TasPers
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