Homestead_Tate Reset From
CLAIM FOR HOMESTEAD PROPERTYTAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
Slate Form 5473(R1711-16) HC10
Presorted by the Department of Local Gownanenl Femme
INSTRUCTIONS:See reverse side for Sing insmxcons.
NOTE:Telephone Soo"al Security driver's icense,state Ithaca ficafon and federal identification numbers are con5dendal under IC 6-1.1-12-37.
'1 , CERTIFICATION STATEMENT
I Me) � a.yTU , • Q certify that I(we)occupied as jr • Ipri Pa
place of residence or am(are)buying the following described real property under contract for which a Homestead Pro i•• T- 5ta J
Deduction is hereby claimed on the date this application is signed. (date of signature). I(VVe):
Own. 0 Am(are)buying under recorded contract DEC 2 0 2018
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 tmst� /
❑ Arn(are)the shareholder, partner, or member of the entity that owns the property.
P LL
Y AUDITOR
Name of claimant(legal name)
OleyprAna (Y1" I air
II prying on mnaect Fee Sipple owners name
DEC 202018
Recorders(Ago,where mmad Is recorded I Redid minter Page
Il • ri .-M—
rowmdp GIBSONTv"!'14`tW ro.mwrnpRIR
tb5o(\ m CCMCT1 . ,t\S\ kt\c
3uPmas11"- Legald I Is tteeafPOParty inQlescot
�17X/-bd 1 W RCm PopartJ 0 Annually assessed mare harre(/L 61.1-7)
If any pdam of the residential structure cc the lend col eIILedg one(I)ede that immediately Anwsds that 501am is treed b produce Income,denote the Use and portico
. of to property tadted to produce tame.
- i1 - OI - 30D ( -CO s . � So -o�\
1 �` PROPERTY OWNED ELSEWHERE BY CLAIMANT
gra,County,end Township
T�J 1 \n b Is davltant vacating a Inmesleadl
1 t V r`M(1 T'fdy{ Yes ❑ No
I herebyce �• ���'e, eal�rtify the above statements are true,correct,and complete.
Address at W \\t�� �� Address dv ten6frsd,d.0(mintier and sleet oy,stare,and ZIP code)
5505 'cam \/.) Wacric'C-S- 6 • nsvltk3T,Nl i th
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON- ESIDENTIAL
VAL
Land not exceeding one(1)acre Immediately _
surrounding residential improvements (1)Other land (2) .
Total land(line 1 plus line 2) (3) •
Residential Improvements or Dwelling (e) _ _
annually assessed mobile I
nianutactured home Garage (5) .
Other improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plat Terre 7) (6)
I hereby certify the above is true,Correct, °o1Assessor Data Signed(non# clay,fa)
and complete.
Verifying adm-6gnature of Auloot Date sped(no+m,hey,year)
STANDARDIDEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed valise/the homestead or S45,009.
NOMithstanding any other provision,the Win Cede dedtCiona invaded in IC 6-1.1-12 m a mobile home S
truths rot assessed as real pnpery or to a nlaedadrned home that is not assessed meetly may
not exceed ore-hat!Waal Me assessed valueu of Me mooOSe home or man home.
Slpalt6e d Auger cJ-s/ \7) Datesigned(money day,KM
DISTRIBUTION:OrgfiL-County Auditor,Fie-Stamped Copy-Taxpayer
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