Homestead_Whitten
• CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4 STANDARD/SUPPLEMENTAL DEDUCTION FORM
See Fain 5473(R1711-16) HC1O 20\
Ictigasir Presorted by me oe{mtlen a real Government France
INSTRUCTIONS:See reverse side tor Wing instuc ions.
NOTE Telephone,Sodal Security,drne/s icensa,state idenfdration and mealand federal idenfrficaffon,umbers are contdenfia!under IC 61.1-12-37.
I(We) m) • cefdy that I(we)ocetiried as my(our)p tndPal
place of • p m or am(am) fogwring desrnted real property under contract for which a Homestead Property Tax Standard
urban is hereby claimed on the date this application is signed. (date of signature). I(We):
OWTL 0 Am(are)buying under recorded contract
❑ (are)entitled t000vpy as a tenant-stockholder of acooperacorporation.ve housing corporation.
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the properly.
:. - - .
diming an corned.Fee Sande poets nem -:
AUG 21 2019
Reardef•oboe where creed is recorded Rand mmCer Page
ifyiii Ids
. -...}.. PROPERTY OESCit:ri3ON: Ly.✓•:R:?.`•, s . . -
Cam w y Tmamp GIB .-..�qe. -•� q !! ." -
Pavl ruder iO^ Legal deeper+ Is to property in question
❑Red pnpeq 0 Arm*messed motes Its(IC 6-1.1-?)
It am porton d ate resbaEal structure or de Mid rot eceehnp cm(1)acre eat irvnactely samnba rim straw is used b Produce Mom.describe re mite as Panes
d de property Mixed to proem beam.
Z(, _'t04 2ti -303 — ono . 06q -02k
•
-' - 1 Y ' 4. WH PROPER-IYOWNEDELSEEREBYCCAIh1ANT E. _
Sts Caret aid
Townt� Is dement vacating a homestead?
❑ Yes ❑I No
I hereby entity the above statements are true,cared,and complete.
Address ci mad(mmeaat aaae4(dArme,and ZEPmd•) Adtlrm of v . ad. any Member ZIP code)
Zoo( w ;v,c k J n—uti-66 6
NOtJ-RESIDENTIAL -
ASSESSOR USE ONLY _ -.1, ASSESSED VALUE;,,I H-- -EAD VALUv,
usro one ) neta '_' `y
s undm residential bnpmvemmb ( ) 3603,-_,zl ,:r
Other land (2) c.."J._ ,`et :1;c4-.ice ';zA
Total land(line 1 plus fine 2) (3)
'y .
Residential improvements or Oreginp (4) >.s-.
annually assessed mobile/ — -- - - -. - u
manufactured home Garage 0) - -.Z _ . . - _ ._..
Other Improvements (6) 4le i nI ;j
Total Improvements(Me 4 through Tine t) (7)
Total value(fine 3 phs line 7) (8)
I hereby certify the above is true,correct, Salaam of Assessor Dee silted(text,dry,)es'1
and complete.
wrdyeg octal-Ste oAndbr Dee SOW(mar*rod:Year)
...-
20_pay 20 Lesser of 60%of the assessed v9ue of the homestead or 645.D00. .
Natertstandng any other ' \ sum or the deducllons provided in IC 6-1.1-12lo a motile home $ -
thaterrofassessedasreal or t0 a manufactured home that is not assessed as resipopery may
not exceed one-hal(1/nW yaks of the mobile cycihone.
SgrrSrsedAmitekle te B 1 et
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4 os tm TRIBON:Original-Co .FaaSlarrptl Copy-Tmrpeyv
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