Mobile Home_Lewis ✓ CLAIM FOR HOMESTEAD PROPERTY TAX FORM r��y�6 STANDARD!SUPPLEMENTAL DEDUCTION
�..=�rY�� Stets Fab 5473(R17/1-16) HOW
4II:r•si'J Presalbal by Ns Department et Local Govamen Finance
INSTRUCTIONS:See reverse side for fling xuWTban'.
NOTE:Telephone,Social Seaallxdrivers license,state iden6calian and federal Identification numbers are contgendel under IC 61.1-12-37.
I(We) n :dr-rnn Q/Y77 onto a 'Stn.
iniyn certify that I(we)ocapied ( ) y I)
described of residence or am(are)buying the following desed real property under contract for which a Homestead roperty ax o
Deduction is hereby claimed co the date this app kation is signed, (date of signature). I(We):
❑ own. ❑ Am(are)buying under recorded contact. JUN 0 5 2017
❑ 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 - - .-
❑ Am(are)the shareholder. partner,or member of the entity that owns the property. Il
- - . • - CLAIMANT'S INFORMATION '• 'i' ?tc'i?'.,75,2,11 W (\UDITOR
Name (bpynesm)
//
n7L_
-
II buying at oaaxL Fee Simple aerteh name
Record/Xs ohm Wen contract is recanted Rend number Pape
PROPERTY DESCRIPTION - - -
Carey Torestvy Tax g diseid(arty,town mreel*
Parcel number Legg&scrptai Is ere property h question '(p;o
❑Rea papery [ Arras%assessed nose Mme(IC 61.1-7)
M are Patten d ere raspmys s a i n r e or Me lend n e t em gore(1)aae Mat Miada.{eh smaubs Met suvmre t used b prottm moire_describe the me at pawn
® el the property tdSmdmpmraimnn D�/ Si/ -
� c yak d
n-`P'q;;S '�i.PROPERTYowNEDELSEWHERE BY.CLA IitA N777-75 �Tyeala }3-_ _77,7417-7,O
Sate,Carey awl TOeshp is claimant vacating a homestead?
❑ Yes ❑ No
Satre of claimant .
I hereby certify the above statements are true,correct,and complete. X v0D ��
Adbm d woad(minter rdslset dN.gide.a'4 ZIPaxe) Address et mated home:mad.arm(nrmeaamear.an;sa.endZ!Pmas)
Z3y L3aXA GaUrt-
•'ASSESSOR USE ONLY --, : i .ASSESSED VALUE ,ic.,HOMESTEAD VALUE 2_ NO VAIVENTIAL ? 4
land not exceeding one(I)acre immediately 2 .yT
sunounding residential improvements (1)
Other land ;:+^,; `}v{. a- =�ti
(2) oboe-:Il s!:.:,-s k_m.::
Total land(laser plus fine 2) (3)
Residential Improvements or Dwelling (4) <rc`- _- _,✓y ^-_T.r._
annually assessed mobile/ _ -fa
manufactured home Garage (5) i -F dI ..
Other iniprovements (6) r a`e'i4 1';n71. -'z`'a'.
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus fine 7) (6)
I hereby certify the above is true,co - t, Sigh °s of assessor Dam d (crueq dli;yea)
and complete.
Velyvg action-Sgnxer°SAUdmr \ \V Dag signed(earlk day:was)
.c.:. >•"-'y �'.STANDARD.DEDUCRONALLOwANCE. - "..,,_ ?(. -.
20_pay 20 Lesser of 60%of the assessed vane of the homestead o$45.000.
•
Notweitstanetng any otherprovisions the sum of the deductions provided in IC 6-1.1-12 to a mobile home -$
that is not assessed as reel property orb a manufactured borne that is not assessed as real property may
cot exceed one-hall(fR)of the assessed value of the rot*home or manufactured home.
SiQtffiee dAUd //��C �/�'LL(i(_� Date N4taf(cvslidaywe)
Sag � s -/
DISTRIBUfON:OtlgiW•Carty Asst Re-Smtrped(-spy-Tageye
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