Homestead_Hinman fl a CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
; STANDARD!SUPPLEMENTAL DEDUCTION FORM -
r� j,•" State Fam5473(R17/1-16) HCIO
Presa ibed ty 9n Departmental LanLa Ooverm ent Firm
INSTRUCTIONS:See reverse side kw'filing ars1=5ons.
NOTE Teteplmne,Social Sean driver's license,state ytea"555 N .nn &nn and federal kte, a&on,wters are oertdentialunderIC 6-1.1-12-37.
Mk)I I `j f .1 . • certify that I(we)occupied as my(our)principal
place of re5�er tor am(are)buying the fofowing desaibed real plwelly under contact for which a Homestead Property Tax Standard
Deduction is hereby dairrrod on the date this application is signed, (date of signature). I(We):
Own. ❑ Am(are)buying under recorded contract.
l�`�n(are)endued to occupy as atenant-stockholder of a cooperative housing corporation.
ACkm
❑ Have a beneficial interest in the bust a the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the sharelroder,partner,or member of the entity that owns the property.
Nate a Claimalty:a1:70
Snarl
.
Seam Seam renter a ctemars spate(be the gut DIres i Otter ' spans(tag pm ayes) tsurt9 Ste
(ggaaak , *+{....,. a t
1 i
1, trill 4,-_l.:: h*..-.ett-r:-_L t _uSe's S -CONTRACT RECORDED.-":_ 'CA- ',.A t 2=""_' O.t'
If eningoo accent. S Fee Simple owns name .
SEP 12 2018
Recorder's tee where contract is reamed Ramdentr Pepe
wedm Ca` _//V�(�'+`1 Toast° GIB "°h Lmcdmrl(ar bee InOMMI'P)
ntm41\hY Legal Wunder' Is the popery gt in es0am
V 0 Red R[prry ❑A'aaa%massed matt tens(IC 6-1.1-N
a ay portion a re reseeded mumse or ere at cot amsYq ale(I)acre that musts*snouts that stmmre is used in promos inane.donne the we and pardon
tins property uths a proms tree.
l.6—‘Gr1 $ 30 1 —o00 . t\ n —02_4
7=71, :7-7. A _...dada _' PROPERTY.OWNED ELSEWHERE ByLIAIA•AFCC: r rS.�_it.=:d- = Fr-.
Sae.Cersty.and Twnatip Is claimant vacating a homestead?
❑ Yes ❑ No
daunt
I hereby certify the abate statements are true,oD(reCt and complete. a /�k Ay i i/1 „�/r .
•.__act dad(ramueawsseet r37.nee.adzlioccd4 .IOrdQtne.11 )..•.— or
Svacaed homestead,4 t�(/(a ter- rv,//shee CSy— eendDPcode)
b YT .
.. ASSESSOR USE ONLY _ h ASSESSED VALUE.'. • * HOMESTEAD VALUE .I NO_: SIIDENTIAL_'- -
Land not exceeding one(1)acre surrounding residential improvements ems' (1) :*`'�- zrcll x '? 'rot s dr
,:u::,y
Other land CO k lV --.c _ ;
Total land(line 1 plus line 2) (3)
Residential Improvrnerds or Dwelling (4) _3;.4T y' ;-'t d:x
annually assessed mobile I __..e-..._ .a:.__r.ti, e _.
manufactured home Garage (5) � '._ E c:it-44,..., —.
Other Improvements (6) 414VtANfiTAV
Total bmpiuy.nwnts(lire 4 through line a) CO
Total value (line 3 plus line 7) (a)
I hereby certify the above is true,correct, Signature ofAste n Date signed(men toy,year)
and complete.
Writing scion-Signature ofAnn On Ogled(roarµ dancer)
'�E -� v: s ',STANDARDDEDUCUONALLOWANCE'. --"', -
20_pay 20 Lesser of ere of the assessed value of the homestead or S45.000.
NWiatffinct g any otherpmvison,the scan of the deductions provided in IC 6-1.1-12 tea motile hone $ •
that is not assessed as real property am a manufactured borne that is not assessed as real properly may
not exceed one-hat(1/2)or the assessed value of the or manufactured home.
SguSvel ,d &4 CSC'S - Oats MEMO(math,days pun
(Asrm9Unat Out-CastyAud3;11 Ssrped Ccry-Taxpayer
Page 1 of 2