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Mobile Home_Murphree ;et, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR`
•
v"..:;' STANDARD/SUPPLEMENTAL DEDUCTION FORM
• F f._. Slate Fam 5473(R17/1-16) HOWPreSorW bymthe Department caeca'Go+arsrs Fiu
me
mm
INSTRUCTIONS:See reverse side for fling insbucEms.
NOTE Telephone,Social Seaetiy,diver's license,state irksracaSon and fatal cafan numbers are catddendalmtlerIC 61.1-12-37.
l(we) �psx-�. �h•
Q aain. our ph tee. certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction�� is hereby claimed on the date this application is signed, (dale of signature). I(We):
Iire vim. ❑ Am(are)buying under recorded Contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporatiat
❑ Have a beneficial interest In the tout or the right to occupy the property under the terms of a qualified personal residence±trust
(3 Mn(are)the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION ,_- '
Soul Seaway number a dements space(last five 6gh) Rivets tene/Idsti5¢.mn I Oesr number of damanes space(last Lae
(AIPs'�fi1a a/YdeFPbwa's span.des me hate a soda aeaisy number
1.!' vt ':. . '1-:• 4 E " ': rCONTRACT-RECORDED T-=--y--: —a- l_- t•Em.. _ti-;.FT U4st,.
.buyrg On omtra,Fee Sample omits cane
ri
Rasmer's ogre Woe centred is recorded
Record rmms,(1/,,,,. a -4r
I . ON COUNTY AUDITOR
Casty Tosealtp ,Texeg Munro ley Lava eetahb)
‘-'- ‘ bSo-n -
Parcel num s Legal desvgton Is the property ndm
airers
cil<F Werty 0 Annually assessed motile hale(IC 6.1.1-1)
I errs pram at the resdaeel mare a Ire lad rut eaee6:g me(1)sae dal hrdedaa'b erraaadt that stouter"is used to Pod®Marra.desame be use ad Portico
of the property utilized to produce Sistine.
a _9 -\Aaa -co - ?goo
-u _... _-i.._. _ PROPERTY,OWNED ELSEY/HERE'BY.CLAIh,A::T - _
Ste.Count ad Touristy Is claimant vacating a homestead?
15,rge 0 Yes ❑ No
I hereby certify the above statements are toe,correct and complete. a( //// _/,f/ '
Address d contact(rxaahsad sheet,at:saa.we Weak) of vacated homestead,a ea meet,sly,sale.and z/Pcosb)
/ fd. r(r', l i . ., ,l.
.. c- _- y@t-RESIDEMIALq
-ASS_cOS R USE ONLY y`I "ASSESSED VALUE Y j_t -I HOMESTEAD VALUE - --VALUE ._ Y :
Land not exceeding one(1)acre Immediately 4-,s az'
m srouremg residential
unix o ,e.rts (I) 4kce.- ;3" -.�_.
Odter land f r am.``
Total land(line 1 plus line A (3)
Residential Improvements or Dwelling (4) Nit'ia.,._ wF_%.- s.;
annually assessed mobile I K -
manufactared home Garage (0) ra r v - r .
Other improvementti - .}Y3-"
Total improvements(line 4 through fined) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is bur correct, SIB olAssassa Dale dared(maM,ray peat
and complete.
veering action-&glare oNadbt Della Sired(moan.day.leer)
20_Pay 20 Lesser of d0%of the assessed value of the homestead or$45.000.
tioMehstanrf g any oterprresslm,tie sum of the deductions pmNded in IC 6/.1-12 to a noble hone f
that is not assessed es real property or to a manufactured home Mat is not assessed as real propsrty may
rot exceed ore-hey(I/?)m the assessed value of Me rmoh harm ornwl acbmd home.
Signt m of/Suety Data signed(rmrel.day.lea)
4 . - , g- lc,- x.
WSTRIBLUION:Original Carty/urear,Re-Sample Copy-TarpaJer
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