Homestead_Young (15) f^. .� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD!SUPPLEMENTAL DEDUCTION FORM
Rea Firm S473(R17/1-16) HC10
Prmaibed by the DePabnae d Government
Loran Gn m ent Fir
INSTRUCTIONS:See reverse side for Elmo hsbvcftns.
NOTE Telephone.Soda!Security divets Rosi st,adte idenfrtrarron and federal it th n numbers are confidential under IC• - 37.
CERTIFICATION STATEMENT -
1(Yve),.S _t ..4' im_ ... 0.A3N cermy that I(we)Cams.;:- , .. f)
place of residence am(are)buying the fofowing deablbed _I - .. under for which a Homestead Property Tax a
a
Deduction is hereby claimed on the date this appfcation is signed, (date of signaOJre f l -
(3- ❑ Am(are)buying under recorded contract. Ru 0 291?
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
El Have a beneficial interest in the trusta the
e right to occupy the property under the terms of a qualified perso �
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. MCVu,
GI•c
CLAItaANT'S IP;FORIdATIOtJ, ) ' _ � • - - r.•�^ - . i ITOR
1r ���nQ
Rewrites sties etl is recorded Record rang Peg,
�[' PROPERTY DESCRIPTION_. • - •
Casey `/ I b Taxts!)� _ dstrd(aT):4m.ram4rp)
Parerunav bLegs£lesata.
e/ Is as prgwty It wesmr
0 Real recat) 0 Annuity messed mobile hoe(IC 61.1-1)
dam preen d to refCBLd aflse or as lae ra eIIYem.g me(1)eau vat i ne ataly surrounds eat stricture is reed b Man hems describe the Me an Pabst
of Its property mined b pease acne.
a;Lil _OS—• 3\ — BCD\— cot . cc a per]
e - Jaye. i,..- :1:11 0pERTY OWNED ELS E1VHERE,SYLCL'Nh1Atif 'mr:'e17: Sci
Slat.Canty,and Ta.nShp Is claimant vacating a homestead?
0 Yes ❑ No
kclamant
I barrio candy the above statements are hue,correct,and complete.
At al canted(nun ererr sage(city:state,end ZIP cat) Advisor of waded tumesIST4 and Shoot•rtY.Sla.end ZaeOdel
• a3, n1 : ncfla' k • t. . 70
1 ASSESSOR USE ONLY ..•I ASSESSED VALUE - -HOMESTEAD VALUE I NO?1-RESIDENTIAL�'
?'I OM .,.VALUE
Land not exceeding one(1)acre Immediately -__ i;al['z <aii4tit
surrounding residential improvements CO '-c.*:x,S:s ,;Vi,2.3t.=om:
Other and (2)
Total and(late I plus line 2) (3)
Ftenidemas mobiles Dwe(tng (4) t`.'s y' :+i
annually assessed mobile I manufactured home hone Garage (5) . _..S_.lt”-- rc�'f.�:'t--•.
Other Improvements (6) x a „t p . _
Total improvements(line 4 through line 6) (7)
Total value (line 3 plan fine 7) (0)
I hereby certify the above Is true,correct, Sgraane cffesessa Data slated(awxh,day,year)
and complete.
Vavy*rg gdon-Signature ofAmdar Date signed(moony day:year)
sass $ s •
20 pay 20 Lesser a 60%of the assessed vane of the homestead or$45.000.
NOMtfsbrxg g any other ppvtsioa the sum of the deductions provided in IC 6-1.1-12 to a mmbie home $
thefts not assessed as real properly or toe manuht hired home that is not assessed as real property may
rot exceed one-hal(7/Q of the assess* of the made home q mart/attired home.
5ipnanne Au or _ J( (mores day,yew) ,
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aSiRIMMON:olaral-CaavyMsraar.PbStriped Croy-Tapeyer
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