Homestead_Sloan (4) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
rl Q,:e. STANDARD/SUPPLEMENTAL DEDUCTION FOB _ n
State Fenn 5473 g I12
t17/1-16) HCIO 0 I<\
Rasabed by Me Depaanex of Lad Government Prance
INSTRUCTIONS:See reverse side for bring instructions.
NOTE:Telephone Sodal Seaaft%tees license,slate ident:cation and federal idutiraan numbers am contdutal under IC 6-1.1-12-37.
1111=9.5,1911111119
ITIZE
I(We) S f m certify that I(we)occupied as my(our)principal
place of residence a am(am)drying the following described real property under contract for which a Homestead Property Tax Standard
�Dedduetwn. ID
is hereby calmed on the date this application is signed. (date of signature). I(We):
y�O Am(are)buying under recorded coated
Am(are)entitled to oaupy as a tenant-stockholder of a cooperative housing corporation.❑❑ Have a beneficial interest In the lust or the right to oLaipy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
. CLAIMANT'S INFORMATION - -
Nae el . name) 'Edentateme) '
Social Seany norther or anuses spasm(fast the a ) Drivers(cMee/IEmei.YAlion I Dew number at daeaa's spouse(last Eve QgRs) (sting State
(grylmSe aNy if epyCmNs spouse deer not have a social scanty iwt ej
. CONTRACT RECORC2i., '.. . -
VbyieonmsYat Fee Sage vents rare - r
(
Remrdeb odd?Warne=tad is=wad Rad number Page
C . err
- _PROPERTY DESCRIPTION' - -Catty Tweet*berate Tang armor(•- ,loom atinst)
Patelrvi
Tf;A1lP.
ta�tle:rpuaa GIBSl0p,Ya,..:S a ,�...Y.
Alrirnf
U Rea.,,._ rs'iwtOgmesaa mobile home(IC air,1-1) , •.,.
e any pax6u of he residential ease a the land net ec twiner c e(1)me ma inna:Saab sa+rwMs that stature is used to Rater Mon,desaae the m aW portion
d the POOaty wired b mesa bcc me.
2b " 1 S --20 -20c&- o o p 0 6I- - a V Li
- = PROPERTYOWNEDELSEWHERE BYCLAIMANT ... -
5.°.may adTp" 7 Is claimant vacating a homestead?
❑ Yes ❑ No
d
I hereby certify the above statements am true,correct,and complete. A Zs /
Addams d coact(number end ant dry,are and ZIPc�) Address ofm vabdlm �',(`yJ'�I`t'l,dmy(ambeer end
tees.ots state,end ZIP code)
7'II q rSt,La-6ti & .3n.
-ASSESSOR USE ONLY - ri • ASSESSED VALUE'"--1 .'HOMESTEAD VALUE.'_ LOt RVESISIDENTIAL
Land not exceeding one(1)acre Immediatey-:. 3"Ea _' 1f s`..'d.' LkI6t1 l
surrounding residential Improvements (1) 3°SE'"y -+.e- v
Omer lazed a) n: ;'?:::"
s,mac-
Total land(flex I plus line a (3)
Residential bnproveants or Dsvemg (4) { �
m
annually assessed mobile I
r 7
manufactured home Giant (5) • .x , e. 4w_''� . :_.
Other onpiovemeats (6) 5e':. .„E-.?._ °-._ ..
Total Improvements(Ike 4 through line 6) (7)
Total value(fine3 pan fine 7) (B)
I hereby certify the above is true,coned, APO al Assessor Data shad(rsxrtJi d heat
and complete.
verifying scum-Signore°Midas Data sired(month day.Yee)
- - - - STANDARD DEOUCl1ON ALLOWANCE . .,.
20 pay 20 Lesser of 6D%of the assessed vrf se of the homestead or$45,000.
No strata tfi g any other provision,the sum of the dechr tions provided in IC 6-t 1-12 to a mobile home f
that is net assessed as real property or to a manufactured home that is not assessed as real propery may
rot exceed one-hat(1R)of lira assessed valet of the roobde home home.
SYaan+edAudbr�M SmN 1, "2 2-8 l- l
•__
D$7Riar1ON:Origin-CaaaayAssdlar,Ft.-$a ed Coo,-TW+aier / \ .
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