HomeMy WebLinkAboutHomestead_Grubb (6) 4,„.--;c2. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
• : STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R17/1-16) HCIO
Presorted by ere Dgmmma id Leal Goverment Raba
INSTRUCTIONS:See veverm side bring instructions. ^'4 J
NOTE Telephone,Social security,divers Sense,state ideneca5on end federal denStabmr numbers are anfidenDaf under IC 6-1.1-i'- 7.
CERTIFICATION STATEMENT -
I(We) • win 1111,YPIay cattily that I(we)oawpied as my( 2019
place of resid ce• am(are)•a •the following described real properly under contract far which a Homestead Property
Deduction is hereby darned an the date this application is signed, (date of signature). �I(We):
❑ Ova. 0 Am(are)buying under recorded contract. }.W IYIMe
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the test a the right to occupy the property under the terms of a qualified pe,aWScithIn eQUNTY AUDITOR
❑ Am(are)the shareholder,partner,or member of the entity that owns the property.
- CLAIMANT'S INFORMATION _ _ . . - ,
- d..J-(tagSnme) /
Solon Scatty cumber of daft sparse(an the Mast Darter's iaaa r IderOS� T iar I Or ins ter d spouse eree(Mal en dcy Meng State
(4rSde avy tlapACcatts spans tee nr d here ma nau's soul seaa3y x )
3 turd an cetad.Fee Simple avers nine
RecorhYa once where wrarad is resided Rend rumba Page
Tor
alatp -
Drool roaster the in question
-la-D'7-cfo/623./3-0as sprli ❑Amp*assessed motel•home(IC 6-1.TO
uany porim or the resivasial strums or ere laid na aree±g ors(A acre tat iruneUa ty tlm saumee is used to produce inane deserts to use and potion
d the PM:eV crazed to produce cam
" _ , . PROPERTY OWNED ELSEWHERE BYCLAIAIAN.T ' _ - r -... -
Saae,Gouty.and Tom:h Is claimant vacating a homestead?
,�Gionattre
L.^J ❑ Yes ❑ No
I
I hereby certify the above statements are slue,correct,and complete.
Mtmdasled(amaivaraafreeL oily,Me and ZIP code) � n�L Mdess al vacated ��d,deny @ntc at as.rYy,Sae.aa/ZgvwrB)
I 11_41 1 Ala A rP aN
• -ASSESSOR USEONLY - _ _ I :ASSESSED VALUE '_ HOMESTEAD\ALUi.F_,1 t OH:RVALUEESIDENTIAL e a •
f Gi
Land not exceeding one(I)acre Immediately (1) tr 1 -r - •
surrounding residential bnpromments _ $, T L"G. '-._ .
Other land (2) .y-
Total land(line plus fine
Residential bnprovements or DerellIng (4)
annually assessed mobile $ ;�
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (tine 3 Was fine 7) (a)
1 hereby cattily the above is hue,correct, SiguLe a(Asseuar Data aigwd(rrntZ rtY.Year)
and complete.
wxyy'eg rum-Scheme or evident Data steed(mama day.lam)
` -'.STANDARDDEDUOTIONALLOWANCE^,7 '_ - _ , - _ _
20 pay 20 Lesser d SO%of the assessed vane of the homestead or$45.W D.
Nohtitstandug any other provision,the sum of the deductions provided In IC 6-1.1-12 to a mobile home $that is use sad as real properly or to a manv7ardued home that is not assessed as real properly may
not ex m�al(t/q of the ease d value of the rmWe or manufactured home.
Sombre r Doe sit p{h,dact ,�
DISTMEAGION:Org'vvl-Carly AuMr.Fae Saanped Copy-T
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