Homestead_Oprisko te CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-' ;:"k STANDARD/SUPPLEMENTAL DEDUCTION FORM
It— '" State Fenn 5473(R1711-1s) 0010
WPresorted by the Department S Loral Government Finance
INSTRUCTIONS:See reverse side Mr grim instructions •
NOTE Telephone.Social Saari*diver's acensa,stem iialyfcaaon and federal ldel>1&cffim numbers are confd ntieunderIC 5-1.1-12-37.
CERTIFICATION STATEMENT -
I M e) ii, r / ' • 0 certify that I(we)oca• tt (.l .. II
• place of residence or am(are)buying the following described real property under contract for which a • .-.4• ..--1 .a-`b
??De,eduction is hereby claimed on the date this application is signed, (dale of-•nature). I(We) C nO s
ICPOwmt ❑ Am(are)buying under remded contract WA( 1 V
❑ 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 qualified personal residence t ;ei
❑ Am (are)the shareholder, partner,or member of the entity that owns the property. —i R
�le _ , pUDISO
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Cantu Township Twig Q9rfrr(oll:taws messhb)
NPat neuter � s faaFep�yis r
8 g a Real RaPab ❑Aaaa%a sesed mob le tone(IC 61.1-7)
II arty palm d th resgaCal saa�se crew land rd meaning ae(1)acre ea ameam*tartans that ao9ae is teed a produce Vane,d cthe the use aid paean
See property ma®1 to aodtro income.
2lP Cd - 3J - Z60co /. 533 OZ7
-fir r : v Xl,_ :17: ERTY,OWNED ELSE:VHEREBYCLAIANT .2:77.7.1"' 777:17 -
sate. Ti
K. Is claimant vacating a homestead?
❑ Yes ❑ No
* �i �°
I hereby certify the above statements are true,cored,and complete.Adressd 0 mtrasl dfy, and zllicr / .aIe#) Address d vacated hammed,a any pater artsAaar.ot/:sab.at Zlm6)
�Wr� .ASSESSORUSEONLY - 1 . 'ASSESSEDVALUE;) _I HOMESTEAD VALUE L•I NON_RESIIDENTIAL
s�(kV V Land not exceeding one())eat Immediately
!f surroundmp residential improvements ( ) �3am' `0y
�- t
r Y cmar<Ki Other land (2) yC u . -
Total land(tine 1 plus line 2) (3)
it Residential improvements or Dwelling (4) )-4 ms
annually assessed mobile I
manufactured
home Garage (5) } ..»^T tl Ac
Other improvements (6) v dx atnieLg td:.
d Tots!improvements(line 4 through line 6) (7)
(t @oiQ Total value (line S plus am 7) (a)
\\ 1 hereby certify the above is true,correct, SipGUa of Dar signed(meek day,year)
{.�`tl�\ and complete.
V,atyvg anion-S+gwae of -,.,,�t'DYa signed(marth,day.yea)
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1 '.-. -.a'a. '- -' -- - "-STANDARDDEDUCT10 J'• OINAn C 7j( iEL7P•Sy.�•
20 pay 20 Lesser of G0%of the assessed value of the homestead or$45.000.
Naamstandmg any other provision,the sum of de deductions providd in IC 61.1-12 to e,male home $
C) that is That assessed as real mtpedy or to a manufactured home that is not assessed as real property may
Ns.. not exceed one-hat(1/4 of the assessed value of the nmbrle home or nantaacmned home.
1 Span dAmber/ Date signed(=rat dal,pia)
DISTRIBUTION:Original-caaayamr,wsaaped Copy-Tasp.•,e
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