Homestead_Andrew w^ e;, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r \,ss STANDARD!SUPPLEMENTAL DEDUCTION FORM
Stab Form 5473 MT/I-16) HOW
Prescribed by the De[mtned of loaf Government Rome
INSTRUCTIONS:See reverse side for Ring bubuc5au
NOTE Telephone.Soda!Seaegx driver's b ease,state itd155ca n and federal 7den63camn mantas are con3de,tal under IC 6-1.1-12-37.
CERTIFICATION STATEMENT lit I
I(We) , II �'1Il'.' l! __ certify(hat I(we)oaalpied as • ' •'•'t ';i
place of residence a am J-)buying the following described real property under contract for which a Ho T -,- .r-•
•-. ' . is hereby claimed on the date this application is signed, (date of ' )
• :. ❑ Am(are)buying under recorded contract.
• Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 111111N 0 5 2118
❑ Have a beneficial interest in the trust a terms the right to occupy the property under the tes of a qualified personal resit a trust
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
ciAga4NrsF FOw.unorl. :, i Jn,,ts t 1S OR
Name drlahmmt(Iagd name) .. Tdepnae nniEad--:. :..�•C'rOUNT r ?..k-
A
Al - r'/ NAY - ( ) (gS0
$o®lSeosity number of dOtrair.spare(last five 6gh) OdntS caeca I Ideiost /Over ester of da:Wt.spade(teal Lee debt) Issuing Sae
(Apparel*.orgy bappocad's sparse dm-have a yodel.mashy number.)
" -F '‘..4"-'i "t';.a-' : 2-•z- - COUTRACTLREGORDED i e-4 t. • -_°- —.--a -t_.•rj,17::-;,..
if tufty an contract.Fee Simple amen nave
RGmtrYs o5®ellne contract C recorded Record mantes Page
PROPERTY DESCRIPTION • . - id i
County Township
Iii&011;a15111.111111.1
Pam rater Legal deraiplm Is the property in aesfior
❑Rod property ❑Annuity assessed moue tea(IC 6-1.1-7)
II any porton d to mewed augurs or the lad net esaedng ore(1)ace as mmebsely summits cut titan is used In produce acme,describe are use and police
of to property Lazed b poise name.
a6-/7 P_E- ozf - y6o a) 7. tioy -_ oz
71 _ .:.,.'am RORTY.OV___D.E_SE_HE_E BY CLAIMAt:T 3rrIT:,:OW•rd r— .�
Y z
it
Sae,Canty,and Toms* Is claimant vacating a homestead?
❑ Yes ❑ No
Sonata dda'anat n n
�'�7I �rI �`s3 -0 cJ. Owe slho ,, .
I!!� -..Aadrersdsamted homestead,aar7(number and abern.ago rate endZlPcorb) W
,-. . . .SSLSSOR USE ONLY .1 A'SSESSEDVALUE - _i —HOMESTEAD VALUE , ,f ION-RESIDENTIAL
fir .:•t..��:,. (1) ' K's -R.'JF' °s
(2) 'L z
TMmfe� ) .a.-r-.[
Total land(Poet plus line 2) (3)
Residential Improvements or Dwdeng (4)
annually assessed rnobgel
mamncachnred home Garage (5) »1.?- r -_"?.
Other Improvements 3 N _i,
Total Improvements(line 4 through fine 6) (7)
Total value(line 3 Om line 7) (a)
I hereby certify the above is true,correct. scarce of Assessor Oats signed(n.mrG1.dry,year)
and complete.
1 Vad)ng=ran-Signature of Amite Oats signed(nxans day.yea)
!v rr ii. ,t. areas----s ,rii _-- •CSTANDF RD DEDUCTION ALLOIVANCE,j *^' 7-�-.=-E !..' -
20 pay 20 Leases of 60%of the assessed vdue of the homestead or$45000.
NoMdhsfandl g any other provision,the sum of the aeaudions provided In IC 6-1.1-1210 a mobge home $
that is not assessed as real propery or to a manufactured home Mans not assessed as real property may
mat exceed one-ha(f/2)of the assessed vats of the mobile home or mamalactrnM home. '
Data• ripe- rterh day eah fel—
O51RIDrnOft Original-CanyAuTSa,Re-Stowed Copy-Tespa)e
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