Homestead_Smith (81) r-, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t- .;-. STANDARD/SUPPLEMENTAL DEDUCTION FORM
IS
S2m Farm 5473(R17f 1-18) HC10
Presatea by the De{eswd of lead Goverment Melanie
INSTRUCTIONS:See reverse side for65ng i sbuatons ` )
NOTE Telephone,Social Security,driver'sicense,slate;deaf:iihoo and federal identification number we confidential under l A• 1-1 3( i
_
CERTIFICATION STATEMENT -
I(We) QM es <(-NA- rcc 1 v" certify that I(we)occupied asroprz3,12 pa�019
place of residence or am(are)buying the following described real property under contract for which a Homestead P rd
Ded;r is hereby claimed on the date this application is signed, (date of signature). I(We):
ISOwn. ❑ Am(are)buying under recorded mead. p1TOF1
❑ Am(are)entitled to ouupy as a tenant-stockholder of a cooperative housing corporation. .�a pU
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal resided
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. OBSI:�`
Nanm et dflt(mye,name)
Social Sanely
( amer of n d (last Der rips*
rassiyembr4 T .
`v
Name of dames some(!a[d name)
Social Searcy number of deeme ds matte(bar Me ambi Oivts i r mrt5ra5afIOa m+r nArd der sporae pea Ere dy:4) . ltav9 Stele(A{pimde aere rryYappa its spare dasrafmveeacdelsemryrxmbrl
a v
a Morn on contract Fee Simple ores name
Readeh oboe Wee mead is recorded Record numbs Page
"' _ PROPERTY DESCRIPTION?
Caml' Taus May,town,Esiens )
L bn-� SO ri c\ce -P•I (Ace �n -
PavJnuaabr to thsambr bitepraprty b giant t
LsSnealpropery 0 Awary asessed cable S :a pit6-r.s-7)
If any police d the residential mumse or I.lab nd euedng one(1)eras that tatmbeely serer that structure is used m produce tune,draibe to we aid palm
d tta prprty wed b produce bran.
ate - \ oS — ° 03e ( 1-�'.
•
- - . PROPERTY OWNED ELSEYHERE BY CLAIMANT -- -
Sat,Carty.and Toe:atip Is claimant vacating a homestead*
0 Yes ❑ No
_ - - - Sb,are of dainwd/
I hereby certify the above statements are true,correct,and complete. �(
Address dread(raabram sheet My,saris and ZIPwa) /6Qes of vsabd larcsteat taR @Intrrm rind,sax stela end EPoda)
// ,ill s% /err Q✓e Pr%aterse .p 7 G7o .
ASSESSOR USEOY.LY -I -ASSESSED VALUE ', ., ,H: Ot-1ESTEDVALUE;_j,_ NN-O RESIDENTIAL
-. . . -VALUE
Land not
ing one
acre
surroundngemms residential bn)provernents Immediately (1) mvr._1rqiS6-. cry
Other land (2) : 2rxFi3,}3 -_,,b471—.-.=~-
Total land giro 1 plus Gyro 2) (3)
Residential Improvements w Dwelling (4) #-s rS,Z-)s v .-, i s
annually assessed mobile I -manufactured home home Garage (S) �-S -1 s,- °- '.-.z.
a =.t v th 1
Other irlprovemenb (6) .,_-.dlt. .:,:<,__--icEi IE4 .
Total Improvements(line 4 through line 6) Q)
Total value (line3 phis Gyro T) (a)
I hereby certify the above is true,correct, SlVtaue oAtNsscr Dam snood(nrntt a>:yam)
and complete.
Verifying anion-Signare of Auditor Data signed(r•aKA day,year)
STANDARDDEDUCUOIJALLOViANCE' - _ - -, .20 pay pay 20 Lesser of 60%of the assessed vane of the homestead or$45.000.
NoMfhstandng any other provision,the sum of the deductions provided in IC 6-1.1-12 b a mobile home $
bat is not assessed as real properly Olt a red home that is not assessed as real properly may
it me-half(1/2)of the assessed va the naa6de home ornwa6acormdhome.
D
-) x da
me(raft ay:
Inn
DISTRIBUTION:C 1ghS r FI.-Corey Copy-Taxpayer t
Page 1 of 2