Homestead_Dishon 09. CLAIM FOR HOMESTEAD PROPERTY TAX FORM
r ' .i STANDARD/SUPPLEMENTAL DEDUCTION
Stab Form 5473(R17/1-16) HC10
Rssmeed by the Department d Local Gowaua1 Reece
INSTRUCTIONS:See reverse side for Ong insbvcdons
NOTE Telephone,Social Seaaf/l(&Ve s Ecensa slate iderth5ca5on and federalldentthcatmr numbers am confidante!under IC 6-1.1-12-37.
CERTIFICATION STATEMENT •
I(We) mi g�Zt ► all_ \ a I •- '11 I a1bke)occupied 4 (. i)c t..:
place of residence a am(are)buying the foUovdng described real properly under contract for which a Homestead P %•-r'y 1- -sofa •
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): .
Uncial. 0 Am(are)buying under recaded contract JUL 1 0 2018
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation-
❑ Have a beneficial interest in the tout or the right to occupy the property under the terms of a qualified personal rest bust
o Am(are)the shareholder, partner. or member of the entity that owns the property. • 1L dV
'7.sUDITOR
flare of demmn(kgd earns)
� .
4'-•=17,1'�J�'.,.."-.1‘n-
. "` s
If drying m ma,Fee ShW oars mtnei .. -{:•i
Reorders dem Wine manta is recorded Read enter Page
PROPERTY DESCRIPTION . - - - -
, Toms* Tang Mena nay,loon Empanel
_•. . mCAN a • at -. MOn IL e a' _am • t J -a
Parcel renter tggs.:..'.._. - 1
0x -c-o1-30o0o' via-oak Raatdmay ❑Aamey assessed motto rano(IC 61.1.7)
If any portion d the residential samara or the land not omet,g as(1)eon Morimmediately strands that mixture h used to proem income,desalba ea use and nsrtion
of the prmaty tebited a;sod=income.
NN
ale, -f -C1 - Soo. oo I- \n ..- O' -1
r - - --_ _- _,_li .._N_.__TA�
- . . u ,.,1�P,ROPERTY,OWNED ELSE:VHERE UY CLAIMANT o- :. » -' �■C 7:;e7.77177).'317
Sea,Cony,aid Tome* - Is dormant vacating a hanestead7
. 0 Yes ❑ No
�v9�>a daunan ���PPP
1 hereby certify the above saterters are rue,coned and Compere. V/�) /
Address of=dad(aaetaaral sbee.tily,ds%mat ZIPm�+) ' d vacated homestead.Jan(number end sheet dlr stab,end ZIP mda)
/' 104 La-) ' 0 0Add.l (...a w z\i 5 . t a _� 746S
ASSESSOR USE ONLY, - .ASSESSED,VALUE- _.l., •HOfAESTEAD VALUE:" .I - NO4_RESIDENTIAL�
':VALUE.
Lend not exceeding one(1)ace Immediately Y z r l- .r
surrounding msidentlal improvements ( ) erg-z!T•t
_ -T
Other lad (2) f- -fzr ..,
Total land(line I plus line 21 (3)
" --Za te .Rasiderdal tnprwama r e o Owam ng (4) . . a--
annually assessed mobile I s
manufactured hone Gang, (5) } a _ .T.. .. `ct,,,c'cf`x
Other improvements (6) tLF:
r - , r eat.E
Total anprvsmvn.nts(tae 4 through lines) in
Total value (line 3 plus line 7) (B)
I hereby certify the above is true,correct, Sagcoae dP.�ror Date signed(modi5 dais Yeah
and complete.
Mining slide-Simal,o olAucLax Oast signed(nmdA liar yea)
-
' -: - r• s e O r s•J O\YAP C .. .. - 1i
20 pay 20 Lasser of 6095 of the assessed value of the homestead or$45,000.
Natsin-tandng any bae hone S
that is notor to a mranufactured home Nat is not assessed as real properly may
not exceed vane of the rmbub hero or marMarhned home. Date gaged bona MY.wad
DISTRISU1SON:Original-Coney Auditor,Fie-Stewed Cmy-Taxpayer
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