Homestead_Wayman CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
E`..� ....,f STANDARD/SUPPLEMENTAL DEDUCTION FORM -
Sate Form S473(R17/1-16) HC70
Ftesatbed iy the Department d Lad Goremeea Eunice
INSTRUCTIONS:See revere side fading hntmcfroru
NOTE Telephone,Social Seaady,daieh drnnse,stale idmddcatm and federal lderd&cafon numbers are confidvldal under IC 6-1.1-12-37.
• CERTIFICATION STATEMENT - .
I(We) -Chaffed
hen der IP buying
t d f e/yI n certify that I(we)occupied as my(our)principal
place of residence (are)buying the following d !property under contract for which a Homestead Property Tax Standard
Deductions on the date this appfxation is ' ned, (date of signature). I(We):
❑ Own. 0 No(are)burying under recorded contract
❑ Am(are) entitled to ocaipy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial irrter st in the trust or the right to occupy the property under the terms of a qualified personal residence trust
O Am(are)the shareholder, partner,or member of the entity that owns the property.
Nave of pegs'name)
�aa m�,#�.a��my � x
Nand spo'ae(legelxmn)
c eig,76
Social S.any
- . CONTRACT RECORDED _ '1' .. -,.
aaON on mtad,Fee Slope onsets rare
Remdeds mhos'where OYCai is recorded Read mantes Page
r PROPERTY DESCRIPTION _ _,. �- •.
/ Marmite T®y.-'-(rdy,•. fasaNp) - id
()! 4/ r Et)
Pad rsvms /+'73,,//fi/gysad�q,6�,oj-n, Isan Peopab NPeaan
Else LE 3et_u�3 9esaceti 0 Arrtaay assessed mole hret6-Ii--Mt
It Etna Parton of Iva residential aware cr late cot exae-rg on(1)me mat / r./ Qva yet srngn is ram t peo1m lemma.desate Me w''//a�fllddl�).4W
of en property mired b produce karma //// /T/d,i/ 11 O
do - olio-63= 6a-0�1?45-2-�/ `J ' •
19
�s
- PR.P-RTY.WNED -S W1 R sY FIMAPi- d'+.`
Stan,Cody,and Township Is claimant vacating a homestead? 0O/TO
❑ Yes ❑ NoR
Square of claimac
I hereby certify the above statements are true,correct,and completeclaim/MA
Address d contact(numteret Meet Mystify,at ZIPS) mated I any(trntereid sheet,sty,state,and ZIPfl)
ASSESSOR USE ONLY 1 ,ASSESSED VALUE ;.-1 - HOMESTEAO VALUE;_, .NON-RE LIUEYTIAL
surrouncfmg resiLand not dential on*improvements Immediately acre ' (1) 1 fk 7' .._.W� 7ti R
Other land (2) Lti!f;7[2-M,}.271:1.24Fitic2
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4) r� - -a :.
annually assessed mobile I t
manufactured home Gang. (5) s .61>. 72
Other improvements (6) _'w- :d:=^t+' a/__-
Total Improvements(line 4 through line 6) (7)
Total value pine 3 pha fine 7) (6)
I hereby certify the above is true,cone(, SignaturecAssazsm Dam signed(uray dais)eN
and complete.
Vaytg mite-Square o/Auctax Dare sacred(mash day,lea)
_ - k •, --STANDARD DEDUCTION ALLOWANCE- - - . .. .. - . ,
20 pay 20 Lessr of 60%of the assessed vine of the homestead or$45,000.
Abtathstandvg any otter provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home f •
that is not assessed as real properly or to a manufactured home that is not assessed as coal property may
not exceed one-hat(1/2)of to assessed value of the mobile home or manufactured home.
Square c&sdbr Date Viand(moth day,men
DISTRIBUTION:Crgia-Casty Audis.Fee-Stemed COPY-Tngelm
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