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. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Fam 5473(R1711-16) HC10
VIS PresalheE Di the Department of Load Gaaanat Fr once
INSTRUCTIONS:See reverse side h r5&g instructions.
NOTE Telephone,Social Seaeiry;divers kefse,stale iderd5cation and federal iderthfragon numbers am confide:fel under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
ll.M) I{ LV � / f*l7 r
CPrtdy lhati(We)• +-' (•-�li`
place of residence or.�r(are)buying the following di-..'.-. %1 Property udder contract fa which a H. _ . . 1 - l
Deduction is hereby -.on the date this application is /red, (date of sign.,.re. - "- .
❑ Own ❑ Am(are)buying under recorded contract NOV 7 2018
❑ Am(are)entitled to occupy as a tenant-stockholder of a coopeidG.d housing corporation.
❑ Have a beneficial interest in the trust a the right to°copy the property under the terms of a qualified personal residence bust
❑ Am(are)the shareholder, partner.or member of the entity that owns the property.
atuyeg Onosnsec,Fee Simple reefs riaro
Roosts case*here mraact b recorded Resod numbs Pegs
Caruo Tovahp Tadrg--- -. ey m town wrnldn)
`."17
10
Parcel rifler -pLegalrcro I. so A C tithe property in P✓esdoa
7T 5E / 9 2- /O eSaaerty ❑Aauery assessed mdi.Mme DC 611-7)
IS eery pafim a tie BspaGal smmre a tre lad oat efepts°one(1)acre tra inmeNapJy snotmas act wore is iced b prose®home.aefa:,e to use at portal
d me Wooly lazed to pad ce ertare.
a6 -/,2 _ / 9 _ Limo - oo/. / 33 _ az ?
" `- ''' PROPERTY OWNED ELSEWHERE BY.CLAIMANT L- "' ` -
SYe,Casty adTownship Is claimant varafing a homestead?
0 Yes 0 No '
--- ---- of de/mart
I hereby certify the above statements are fire,correct and complete. j%(]`'�l/�0/�{y/
Address M mreaa(nubvad tee(sax--- and ZIP cork)411/
af.aalea rap(number cll:
bertls , s�e,and 2TPcade)
2
I 3-5. So E, �'Ia��_7o t>1fv y21,71
jC NON-RESIDENTIAL
Land not exceeding one(1)acre immediately (1) Et "%4-. Va s - `:i
surround-mg residentialimprovements
Other land (2) ?Ii ';:c '- €..4��_--'
Total land(line 1 plus line 2) (3)
Residential Improveen or Dwemng (4) F. _-'s r
mt
annually assessed mobile/ $ n
manufactured home Garage (5) .� 4, .
Other hnprovernenm (67 ?r -:a b-.Mc�- .--' -
Total improvement(lime 4 through line 6) (7)
Total value (lime 3 phs Gas 7) (e)
I hereby certify the above Is Due,correct, SgeAre ofAssess a Dora sired(c Tk dace Wan
and complete.
Vaiyig auw-Siasute°Mucha Dos steed(myth day:Yea)
. .-
20_pay 20 Lesser of 60%of the assessed vdue of the homestead a'$45,000.
NohKJrstanlrg any other provision,the sum of the Streams provided in IC 6-1.1-12 to a noble home $ •
that is riot assessed as real property or to a manufacbred home that is not assessed as real property may
note teed One-hat(1/2)of the assessed value of the mobile home or mamlacoeed home.
S)4 7AtEb , i// L Ore signed(north day,yea')
DISTWeITflON:Org'val-Carry Audiew.FMSomped Copy-Tameya
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