Homestead_Dike ,`^s& CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR -
4a ; STANDARD/SUPPLEMENTAL DEDUCTION
Stab Form 5473(217/I-16) HCIO
Prescribed by the°electivity of tab Go twat Finance
INSTRUCTIONS:See inverse side for fang iubucGons
NOTE Telephone,Social Seomlgs otiverS Bwea,stns i 5caSOn and federal ICenticaf ,numbers are conitnal under IC 6-1.1-12-37.
e1 Mp) certify that I(we)Dcxsspred as my(our)principal
place of • or are)buying the foiowing described real er contract for which a Homestead Property Tax Standard
De, is hereby claimed on the date appfxon a5 is signed, (date of signature). I(We):
Own Am(are)buying under recorded contact
L> 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 bust
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
Tang avid(od):own tecttlp)•
160,30A -
in mesdac
Red laryalr ❑Molly assessed mode hone(IC 641-7)
a erry portico of the razperpel sincere cage land not meeting are(I)eon Rot immediately erred$Ran snareie used o{sedan inmene,Mamba Me use end Intro
d the property Mired to raod,re bum
-z 6- 1'8 -2L —202 —GOO.0)6 —o26
-., ,, ... [-,-, ROPERTY OWNEDELSFa bit OY CL IAMANT ,_ . _ =' v.r;a_
axe Coady,ex/Township Is claimant varatng a homestead?
❑ Yes ❑ No
Square of claimant
I hereby testify the above statements are true,corec•and complete.
� •��1/6/ // •'
Address et anted(amdaad strati a T,.a and ZIPtole) a( it (number end ast<( sb,end ZlPepe)le
y .0 tsC _ u a - ai _i. 9'
:-.
ASSESSOR USE ONLY ,U'r 1 ASSESSED via,/ I HOtdES_TEAR VALUE ,-I SON.IzAL1UENTIAb
Land not exceeding one(1)acre krunediately
slmouldmg residenttid=movements (1) 3j r f
Other land (2) ... . 't4c:_J.-)_ .....
Total land(line 1 plus tine 2) (3)
Residential Improvements or O1ve01ng (4) e„c I�`
=Way assessed mobile/ ( ) YF -' - s'
:-
manufactured home _
Gaspe _e°r..E_'�'�..�.-f: _ .
F,i'
Other Improvements (6) Tyrs -.e b;}4e
Trial Improvements(fine 4 through line 6) (7)
Total value(line 3 plea tine 7) (6) .
I hereby certify the above is true,correct- Square ofMse r Date awed(morxf5 my,year
and complete.
Vegyng action-SIWUVa Of A&dex Dab signed(remit my.Yew)
20_pay 20 Lesser of 60%of the assessed eaue of the homestead or$45.00D
Noinwtsrandog any oglerem>visiret the sum of the deductions prrvlded in IC 6-1.1-12 to a mobile home $
that is not assessed as real properly or to a manufactured home assessed as real property may
not exceed ore-has(1/2)of the assessed vete of the or home.
Sglmre a
Dale aged(made dry,Yvan)
S" ,ei„A S C 1h CSIS 8-6- 18
DISTRIBUTION:Origicel-CareyAu:De,File-Sormed Copy-Taxpayer
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