Homestead_Stewart (10) •9 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
E. :^ STANDARD!SUPPLEMENTAL DEDUCTION
`•�.i',, Stab Form 5473p117/1-1er) HOW!� Presented by be Oepsmiaa or teal Gram ma Fish®
INSTRUCTIONS:See reverse side for firing insbuctaa. '
NOTE-Telephone Sodal Security diver's license,state idenfacabon and federal identalcation numbers are conidenlial under IC 61.1-12-37.
- CERTIFICA11ON STATEMENT
I
• I Mla) a certify that I(we)oncupted as my(our)principal
place of residence or am(are)buying the -op ' ..described Mai property under contract for which a Homestead Property Tax Standard
jetIn Is hereby claimed on the date this application is signed, (date of signature). I(We):
Own. 0 Am(are)buying under recorded contract
❑ 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 residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
CLAIhAFNP5 INFORIdATION - _
t
Sods Seaaty smear at daemKs amuse(last Ere agar) Odsers Coen/Identhismon I Ober nmmer at claimers sparse Min Eta
(ArparUds e°dyeapp5anta spouse does nal taw a so ) gi tr
I
. „ -'SA- r- _: *. _;S a'+ CONTRAGTOGCORDED s-.' :sr::: N.tt - ,-a:•
It tsano on comas.Fee Sbple comes name
r d 212018
contract
Recorder's Mhos Where co is rcam d
- - PROPERTY DESCRIPTION'S _, il-cfpf�.\"��q nYCa
IsBSON
ere
Cart Toartsl4 Tame Maiatr3y.trent to•+mhlp) . �•.Cu....
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Partxll411) legal asalp'a+ properly in question
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0 Red Prperly 0 Atonally assessed mode harm(IC 6-1.1-7)
I any padon d the residential asrtre or the lad not emstig ore(1)acre that immediately saranm mat structure is used to produce hmne,macaw to use and paten
d be progeny Mind b produce Moans.
26 - 12 -to 1 - Lip 3 -000 1 - D28 .
Sib,Covey,and Toena ip Is clamant sage,lb a homestead?CIYea, No
I hereby certify the above slaterrnafts are true,cones,and complete.
Andress of moat(nwbarasd meet city,sue,and ZiP---. ar aabd homestead.y any Slumber and shed,ray:date,at ZIP cods)
.•ASSESSOR USE ONLY �,! _ ASSESSED VALUE',e 1 HOMESTEAD VALUET_'� 10 RFt QSIDENTIAL,=f;ti'
U
Land not exceeding one(I)acre Immediately i ;--i_: -F "41 4,1
a suounrTmg residential improvements ( ) r- ,--„-3I: 'r?..., �7,'- s
Other land (2) '.. E e. . _
Total land(line 1 plus fine 2) (3)
Residen11al Improvements or F Owa0ing (4) J '` k.•id sus £;;
annually assessed mobile/ :
manufactured home Garage (5) `c i Y `'t cr tv
Other improvement (6) u - •` r ^-
Total improvements(line4 through line 6) (7)
Total value (elan 3 pis fine 7) p))
I hereby certify the above is true,correct. $gha5xe d A<ex.a Oats signed(Inca tax Year)
and complete.
Vedlrng arm-Signature oN6br Oats Sealed Ora tax Yea)
a734+A----:dhLY:- s•hn._`ifiria.,..a...---- s s a a aYlatii•_a'fr51iU: +iitikvi a-ia-.• ;:car;.
20_pay 20_ Lesser of 60%of the assessed value of the homestead or 345.000.
Nd»idubrcemg any otherprcntion,the sum of the deductions provided in IC 61.1-12 to a mobile home S
Thal is not assessed es real property or to a manufactured home Mal is not assessed as real property may •
not exceed one-ha,(1/2)cif the assessed vase of the mobile home or mamAacbumd home.
Sg ere ckndbr Data signed(nedh,day,Yea)
L� r1121- Ili .
DISTrisunnON:Original-CastyAa sx,Fl6sanped Copy-Taweyer
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