Homestead_Patrick Properties LLC CLAIM FOR HOMESTEAD PROPERTY TAX
YEAR
c STANDARD/SUPPLEMENTAL DEDUCTION FORM -]
Stab Form 5473(R17/1-16) HCIO .0 ICI
Prescribed by the Ceaaaaae of Lam Goverment Fimxe
INSTRUCTIONS:See reverse side for 52ng instructions.
NOTE:Telephone,Sodal Security,diver's Ecense,stab berdijo5on and federal IdentrEcafion numbers are mnfrdenial fader IC 6-1.1-12-37.
__
I(We C- . certify that l(we)occupied as my(our)principal
place residence or am(are)buying the ' d 'bed real property under contract for which a Homestead Property Tax Standard
• Deduction is hereby calmed on the date this application is signed. (date of signature). I(We):
❑ Ohm KAm(are)buying under recorded
contract
❑ Am(are) entitled to txxu as anant-stockholder of a cooperative housing corporation.
O Have a beneficial iraerest in the trust or the right to occupy the property under the terms of a quaffed personal residence trust.
0 Am(are) the shareholder, partner, or member of the entity that owns the property.
ci
Time dnamed gelname) •
Soda Searcy
a space tad a•e darn) tssdng She
(Appaade dry t app6wts space does not Draw a sock/warty ara&4
If a*G UI coda],Fee Svvpe ones rums
nt.. P ti L.l_C •
Readers e6=etwe=tract s recorded Read rumba Page
Casay \y�- T ^' \}.1� Tate deeid(city,men.mwNYp) - ..
Pam mercer , �Y ` to 111/,-/ ` I` .nWastnm
,. Rcpssl ❑A+aeA'usm ni• af nth tame(K6f.1-rl
ratan
If ere Pan a tie re;lops scums a an lad not emeettg me(1)acre con mmedaely is used bpeodmoe income,drown as to an prmai
d ib properly offered b palm income.
( 6-\2,-. o 1- 10k - COO E 16. -o 2-.R. .
PROPERTYOWNED.ELSEWHERE RYCLAIMANT _ - . ..
are,Carey,all Town, y Is claimant vacating a homestead?
❑ Yes ❑ No
Senetreof
I hereby certify the above statements are true,correct,and complete. —fa—
Address
dcaiyad(rxsmEerradsheet tit;rater endPPcods) .. _.
:
Other LI M 0 r
r•
Total end Urine 1 plus lure 2) (3)
Residential improvements or Ovreging (4) L .s t ) }..
annually assessed mobile/ v'
mamutad rod home Ganger (5) APR 2 9 201g 3
Other hnp rovementS -_ (e) - s' ^r ii ;ii sx"
Total improvements(lox 4 through fine 6) (7)
Total value(fine plaline 7) 03) IL3EOM COUNTY AUDITOR
I hereby certify the above b true,correct. ire dAssassa G Dar Strad(avyh der;deal
and complete.
Verifying Mon-%mare d Audnr Data signed(va ch dig/ea)
't, . - - - - . ,h STAnDA RDDEOUC11ON ALLOWANCE: . . __
20 pay 20 Lesser of 60%of the assessed vr;ue of the homestead a S45.000.
Noteldarxirg any other provision,the awn of the deductions provided In IC 6-1.1-12 to e mobile home S •
that is not assessed es real popery orb a manufactured home that is not assessed as real property may
excee
d ed one-hap(112)of the assessed vabe of the mottle WacbnM home.
Solaro et Aune)LL sm(k C 1 Date signed�12q`• 1°I
DlsiRa ION:Original CaseyAtx9a,Ra-arwed Copy-Taxpayer
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