Homestead_Meyer -Reset From
:i n4. CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR
/; 4 STANDARD/SUPPLEMENTAL DEDUCTION FORM ICI '
state Form 5473(R17/1.16) HC10 20
.. Prescribed by the Department of Local Gaermrcm Finance
INSTRUCTIONS:See remorse aide for filing insbwmns.
NOTE:Telephone,Social ''wiry,dnvTels kense,gate idenditadon end federal i en:kabon numbers are o nbal under IC 6-1-1-12-37.
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I(We) I/ v l Y -Q .P� certify that 1(we)occupied as my(ow)principal
place of residence am(are)buying the following desrn real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
fe wn. 0 Am(are)buying under recorded contract
O Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation-
❑ Have a beneficial interest 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.
CLAIMANT'S INFORMATION -
Nameof t(iegal,ame) T
Spin
rwmDe, ` '
Name o tY gas(legal name) Y I rw� V
�� � _Lrf1P
smel seavYy nurmer of N s sate(ma The mug) 6N'els I HenfSutm l ONer ruitCer of deiront's spouse(mY E.e dgnl Issuing she's
.ayam,n) ��
U Nryng on contract,Fee safpe wseerr/nnaa e
/ /
R came. race seers contact Is recorded Rend water Page
///jJ�/ c [,Yf�[yy'/�y'') 'PROPERTY DESCRIPTION
V e J 0.z/ T d ' r ric9k I Taxing d¢Oitl ,t
...number Legal desoance Is the roomy.s wesmc
0 Real lateen" ❑Annually assessed mapae home(IC 61.743
If any portrtn of the residertal structure or the land not eacaedng see(I)sae that .i..derh surrounds that our sure S used m produce insane. ncwne,desate theti use end poon
aWthe
property led b Voasce
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,Cindy,and Township •
Is•. .m . •a tlgogead?
0 .p IIa No
m�
I hereby certify rn the above statementsare Due,correct,and complete. <
/
1/
Address of mtud(number and sees,cry gate.and 21Pmde) of
•
ASSESSOR USE ONLY _ I ASSESSED VALUE I HOMESTEAD VALUE I NON ESISIDENTiAL UE V 1'„Jv_,ll/7! O
.
Land not exceeding one(1)acre immediately
immediatelyn
surrounding residential improvements -
Other land (2) �L 'u Ii
Total lend(lineplus line 2)lrn (3) Nm se,
Residential improvements or Dwelling (4) -
annually assessed mobile I manufactured home Garage (5) MAY 6 2019
Other improvements (6) _ - -
Total improvements(One 4 through line 6) (T) s!{/J�µpl, t/-/�//J�I�'P7{I'7Ts'II9'/_.
Total value (line3 pia lint) (6) /_' UNT' �r AUDITOR
I hereby certify the above is true,correct,
siganneoTAss(a1BSON CO Dam signed pnprnN east,
and complete.
V>Jsmp aaa,n.SlgneNue oiNgbr Date signed(moaner day,leer)
STANDARD DEDUCTION ALLOWANCE .
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
Notvathstandng any otherprmAsion,the sum of the deductions provided in 1C 6-f.1-12 toe motile fame S
that is not assessed as reel property or to a manufactured home that is not assessed as real property may
not exceed one-half(112)oI the assessed value of the mobile more Or manufactured home.
sigxa5tre of Pod: Date signed(mgai day.Yeas)
DIST Wm mON:Origin-Catty AuOAr,Faeairped Copy-Taxpayer
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