Homestead_Bennett �-1' -, CLAIM FOR HOMESTEAD PROPERTY TAX FORM
- YEAR
-_,....:.��, STANDARD/SUPPLEMENTAL DEDUCTION
Sea Form 5473(R17/1-15) HOW
Presolted h'die Department of Loa Government France
INSTRUCTIONS:See reverse side forging insbuc5atc
NOTE Telephone.Soca/Securfa drivers fcense,stale 6Ynflarbos and federalberID3cabon numbers we coM4eniial under IC 61-1-12-37-
- I(We) r certify that I(we)occupied as my(our)papal
pace of residence or am(are)drying the following desoibed feat property under contract for which a Homestead Property Tax Standard
Deduction is hereby calmed on the date tt is applications signed, (data of signature). I(We):
❑ Own ❑ Am(are)buying under recorded contract• Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a benefidal interest in the trust or the right to occupy the property under the terms of a qualified personal residence bust
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
- - •
Carer --. - Tang dirt(cdy,lean oeraMp)
Peal name laglIddetsaipton Is gr pmpety it euesdat
❑Real acaaty ❑/axmfly assessed mobile faro(PC 61.i-7) -
If awry portion d re matle tar saucers or the land net exceeding one(Nacre Oat lenedaely aeronde Oat mare is teed to produce income,desrnba me m aatl pardon
d tin property adted b produce beam-
(9—lao?— Wo3 .-00I . .& 86 -09:,
::-.4,..r.-.. --- $ ,trz-�.�.r a '}PROPERTY OWNED EtSE:VHERE BY,CLAI(v1ANT -;;iq`:' K':r7..)1Z V
State,Carty,and Tauten Is claimant vacating a homestead?
❑ YYee�ss 0 No — Ay
1 herby cediy xm above statertlfa2s are fire.mreU,and complete. A� y !'° - 'v '
Mass al�(amtlererr/ -. ,ste,and ZIP r ca harataad sany aeffieet,rte;YSe,end Z/Pcads)
SFALL . [, . I,•4 , 6 O .•ASSESSOR USE ONLY ;" _ ASSESSED VALUE �. 1 HOMESTEAD VALUE =-CI - t OJI RESIDERTIAL '.�
VALUE
Land not exceeding 1Z
sunoundmpintial improvements (1) - ^O }-
Other land (2) > ..':=.•
Total land(line 1 plus line 2) (3)
Residential improvements or DaeHng (4) :x s - ..?. `ii
annually assessed mob(q I
manufactured home Garage (5) _,-, r .'-...`!
r -
OMer Improvement; (6) d - ,1_ --
Total improvements(line 4 through line 6) (7) ... . _._ --
Total value(lhre 3 plus line 7) (8)
I hereby certify the above is true,correct,
5vpaave dAssessor Dais signed(ncwY,my.haul
and complete.
Vatiyig amt-Signalise of roar Oats signed Mani day,Mar)
-
i;,a,-1 tr_--.r. : 6.r t - -r STANDARD DEDUCTION ALLOWANCE' S „„_ -3"
20 pay 20 Lesser of 60%of the assessed vane of the homestead or$45,000.
NoleiCUfardrg any other prevision,the sum of the deductions provided in IC 64.1-121 a mobile home $
that is not assessed as real properly or to a - • -. --home Mans not assessed as real property may
not exceed one-hat(irq Sthe assessed sabre She 4 home ornunufacbaedborne.
Sp�.edwmdb Lei Oa Signed is 1
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06TWBJnON:Original-Carib/4S FileStanped Copy-Tagaye
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