Homestead_Shomate s s.. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
F } STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sae Form 5473(R17/1-16) HCIO
Prescribed by the Deanery d Loral Gbuamma Fire®
INSTRUCTIONS:See memo side for tang iubulianc.
NOTE Telephone,Social Seaalty,driven Deena state itlib'Sration and federal idengration numbers are mrffiMttial under IC 6-1.1-12-37.
I(We) / ere r 4 -4-, • 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 ay the date this application is signed, (date of signature). I(We): tact
Orr. 0 Am(are)buying under recorded contract. Q/� %e
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. SO r9
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal resid4(ge • `0/8
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. O
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etoyia on cote*Fee Shah cones tunro
Reastish idea obese contact is recorded Record number Page
., - - . - PROPERTY DESCRIPTION- - • - ,.. - _.
Toroth% T-- ......(ray yen mmaiip)
a . .iy t •i
Perm caner i r" n / . 73�—se,. L�.
,I/ •i of (�(J i-/6 Q��9Parr ❑A•.amly.ea®edmoli.,asm.(ICo-,.,-n
ti any of the material Clare a to land nil eat Ming me(1)we mat nanedztey irre:used to aaam'vane,denote Pe err paiam
d to pi%soya abided b Padre Vane.
cfG- 05 02( fr`"daaooa. ao?,3 -oar s
�:PROPERTYOWlNED ELSEWHERE eYCLArMANY'''. , - ..
Sam,Cary.and Tomah% Is claimant vacating a homestead?
0 Yes ❑ No .
Simaae of claimant
I hereby certify the above statements are true,cared and complete. i l� / a , a _ -/
J1aK 1,3aroa 1 � r� ✓LW�u
Andreae d anbd(number and steel,cry.sfe%end ZIP code) d banestad,ray Counter ad sheet,ray.fie.and ZIP code)
X - o ' a .1
+ASSESSOR USE ONLY -. --t -: ASSESSED VALUE ,;.� 'HOMESTEAD VALUE.... NON"RESIDENTIAL
Land not exceeding one(1)acre Immediately - .l c`. is m O
surrounding residential Improvements (1) .> ..`:'„_L-._..__Y'4-.i.c=:
Other land (2) i v-:= 7rv+�ro:: s+
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4) i_-. :- `
annually assessed mobile l a
fa
manuctured borne Garage (5) If .4� r,,r, '..r ,_
Other improvements (6) _.:.. 4f;;M.'-i911 .
Total improvements(line 4 through tine 6) (7)
Total value(tire 3 pAn line 7) (6)
I hereby certify the above is tire,correct, Sipwmre dAsesaor oar'sped Pot*oil:lone
and complete.
VedW,g edim-Sipraae el Audi"' I) timed(month day;war)
20 pay 20 Lesser of 60%of the assessed vSue of the homestead of 745.00D. .
NoMehstatxlrg any othe`pmvisinq the sum of the deductions provided it IC 6-1.1-12 to a mobtwe home S •
that is not assessed as real property or to a manufactured home that is not assessed as seal property may
not exceed one-ha?(1/2)of the assessed value tithe mobile home Or namdacbmM home.
Simaere oSNndbr Date dread(months dal:yeas
Oti Vn 1RHON:Original Casty Ao x,Fle- i'ped Copy-TeWata
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