Homestead_Mosier (2) e ' er CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
Stab Fam 5473(R17/1-16) HC10
Premaed try ere Department of Local Gramm.Finance
INSTRUCTIONS:See reverse side for lung ersbvctims.
NOTE Telephone,Social Seaalf%driver's kens.sttateeiickvalloton and federal m ca6 ambers are confdenaal ceder IC 6-1.1-12-37.
1 1 t(.C I Mt)) IA LA.,. J • certify that I(we)occupied as my(our)principal
place of residence or am(are the following desalbed real property under contract for which a Homestead Property Tax Standard
Dedri is hereby claimed date this application is signed, (date of Signature). I(We):
G Dwl 0 Am(are)buying under recorded contract.
❑ Am(are)entitled to°coley as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust cc the right to occupy the property under the terms of a qualified personal residence trust
O Am(am)the shareholder, partner,or member of the entity that owns the property.
name a
Soar S.oerty runner of tleasuarts span gut... Oneslicm®r Nmv4dv+l OTr natter a Mantra spouse(Mate dgty lasting State'
(Ap6mtle only)eppeeN'a spouse dam net have a sow smarty amber.)
. •- CONTR.:._REi.Or,DED . - _ - _
- _. .
IfonPo bury cat. e Single amen nave 1 1 I. lilt
I .1
Remde's cam site catrad la remdad Read amber Page
NOV 16 2018
-_ _ PROPERTY DESCRIPTION ._' -Casty - Tore.
anal natter Legel descripion GIBSON CO tt1fo1*inialsim®R
0 Real acpesy 0 A.nuely=tamed made lure(1C 6-LI-7)
"Item pa d the resklental aware a all fink not scee01-g one(1)roe that immediately summit that structure is used to ant.Mlle,aerate the me ad portion
--
d the property mired b pods.boome
•
es", - l a--0 --Li D a- (903 -) ai - 0 a8
PROPERTY OWNED ELSEWHERE BYCLAILIA NT • _ -- -
Sea.Carty.as Tomslip is claimant vacating a homestead?
O.Yes ONo
Adamant
I hereby certify the above statements are true,correct,and complete. ./l/y'�1 a
lz ( nerredrtohs slae aid llPee) / ,• y.'�.
and
#ew,dtyl�s.and ZIP cad)
p a
A. I E . 3n „ a 5+. •
-ASSESSOR USE ONLY ASSESSED VALUE ' I Hb1 OESTE D VALUE -I.SE - Nor)-RESID NTIAL.
Land cot exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2) -a-
Total land(lice 1 plus fine 2) (3)
Residential Improvements or Dvmaing (4)
annually assessed mobile/
manufactured home Garage Tr s
Other improvements (6) ,.., °_
Total improvements(line 4 through line a) (7)
Total value (lire 3 pits One 7) (a)
I hereby certify the above is true.correct. S +e dAsae.sor Dab Biped(nnt%ma/emu
and compete.
Wittig aseon-Siguave Wyche Dan dged(n»rs3 dfi:]ea)
_„_ _ -, `STANDARD DEDUCTION ALLOWANCE
20_pay 20 Laser of 60%of the assessed value of the homestead or 645.000.
Nobe;hstanci g any other provision,the sur of the deductions provided in/C 6-1.1-12 to a mobile home $ •
that is not assessed as real property or to a manufactu that is not assessed as teal prope*may
not exceed one-ha of the assessed value of the home or rteet/attuedhhome. Date rSytaxaaaGtr Lis L
DISTRIBIITR)N:Original-tastyA bon,,Fie-Stamped Or0Y-Tama.-
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