Homestead_Tenbarge �^ .. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD!SUPPLEMENTAL DEDUCTION FORM
r • r'� Sate Pam 5473(R1711-16) HC10
Resofbed h the oePamrwma Leaf Oovensoae Fiance
INSTRUCTIONS:see reverse side forcing instructions. yp A '-J
NOTE Telephone.Soda)Sepailit thwart license,state ids bon and leeral)den alcafmn numbers me oonf e IC 6-7/12 37,
CERTIFICATION STATEMENT
1:1
I(We e•1.-. •• I raj !7//��i•�lll�a v I certify that I(we) as rtiy(sea
of residence a am(are)buying;re following described real pro.... ,.= contract for which a 1 4�
Deduction is hereby claimed al the date this application is signed, (date of signature). I(We):
Sow ❑ Am(are)loafing—under recorded contract
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. �m " . -".
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms ale Fp3t6tletl1pEr5ptr�t{sitlehCdGrLst0
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
-
- - - -
Carey Township T theist(My,icon Moms*)
Parry nutter toga deadpan Is the meaty n gssYac
Red Pr:perry 0 Annually assessed mobb tame pC 6-1.1-7)
V any mean den rmunns sham a Me land net exceeds);one(1)me Cry i meeketey surnamed that structure is used to pmdlce hxnn,destine era use avi porker
a 6n popsy tilted to produce insane
Zc,-/ S-615 L3CO 6)05553- cal
ssg,- i:.c _;,.. :1PROP,ERTY,OwNED ELSEWHERE EY,CCAIMAIlT "±u ,..;Y ,as r�>
fie•Ga^'y,ad Tasman Is claimant vacating a homestead?
0 Yes 0 No
Sy+rtedip amae
I hereby certify the above statements are true,wrtGer,�and complete. 1,—Caeor Wv '�I/1{'s
Adaess a weal(mmtbtarsl street aft side,aid ZIPw yp.br) e A)Stl l ldl. Adam a van ,E any(mat- .o%ewe,end EPmm)
• • _ S Soo
fir_= ;ASSESSOR USE ONLY ASSESSED VALUE.s- HOEIESTE`D VALUE.� Ig4S t 0%nr ESiDVALUEhTIAL'-_�'
Land not exceeding one(1)acre Immediately
saioundarg residential improvement, (1) _ -- -.�:.>m..-;'-•.-_-..- -z,.-.
Other land 1sG.t-.-. -- -
Total land(line 1 plus line 2) (3)
Residential Improvements or Owefing (4)
annually assessed mobile I '--_
manufactured home Garage (5) _ r` - _
Other improvements (6) z 2
Total improvements(late 4 through free 6) (T)
Total value pine 3 phis fore 7) (B)
I hereby certify the above is tore,correct, ` a°tAssessa Day tweed(m°rt1r,day,yeas)
and complete.
Vaying mem-Sgnama otAudma Dap sigma(na1lt day,lea)
STANDARD DEOUCTION'ALLOWANCE ` - '.r -
20re pay Ir• r of 60%of the assessed value of the homestead or$45,000. - .
Nohsithstdag any other provision,the stun of the deductions provided in IC 6-3 1-12 o a mobile home f
that is not assessed as real popery or to a manufactured Moo titans not assessed as real properly may
nal exceed one-hat(II?)of the assessed value of the rmhle borne or manufactured home.
CQ� Data wand(math day,
DISTRIBUTION:Origia-caveyAtega,fee- wad Copy-Tamayer
Page 1 a 2