Homestead_Pohl (13) •
'* CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Farm 5473(R1711-18) HCIO 2(1 ,
Wii Po:sated by the Departure atGovernmentnoncel Goverma nonce �✓`1
INSTRUCTIONS:See reverse side tor tiling k,tndoim
NOTE Telephone,Sodal Security diver's license,date ilenb.YaSm and federal ids tbrat n numbers are oon:derdal ceder IC 6-1.1-12-37.
CERTIFICATION STATEMENT '
I(We) J ` 747S. c- •Q certify N a at I(we)ocpled as my(our)
principal
place of residence a )buying the following desalbed real property tinder contract for which a Homestead Property Tax Standard
Deduction is hereby an the date this application is signed, (date of signature). I(Nk):
m ❑ Am(are)buying under recoded aintraa.
• (are)entitled to oaupy ad
atenant-stockholder of a coopeiative housing corporatom
O+
❑❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a quaffed personal residence bust.
❑ Am(are)the shareholder, partner,or member of the entity that ours the property.
a
P • ohl . /
-
Soval rts (lasFe duds) divers farmer aellrraonIIOere
..,..w 'mmM.)
Nmng oeralnin- g _
SomlSSeary rneeof drowse �T1 f�VlI
(last an cages) Dme's Imm l/lda�vhcation I'OOowrrunbc of de:mat14n¢e(lass the dyrtr hue'g State•
tVn.mtlaaNtlJ 1'Ci.LJmlm..a mdr eusxymmxy I
\`
Utopia at tw Si
I.Fee rob cents mane 1
Reoadeh o aWere cartes is recorded Record renter Page
_ _ . PROPERTY DESCRIPTION - - - _
Cmny < Torsi* C radng Gait(oTy,rear,tamest)
G1�j300 , I NO A- .
P'¢Ir.ca3e` legal eisayla+ is n yesYai
`J Real PrRab 0 AmarmIty assessed note have(IC 6-1.1-I)
It am;atm S the rehabs smdve or ore lam nra emedy an(1)sae that iuvsndn y smrmre is used to pmdrre Income.desote 4e use aid Gordon
of the proprty'saxed to produce dame.
D6 - I 1 - 2\- OO -0 o2- 0t46 -0, r .
- -. PROPERTYOWNEDELSB.YHERESYCLAIMANi - -.. _ _
See,Cant,aid To nslip .•s daancot . . :twrttestead?
{V/- ¢ 2 p
❑ Yes ❑ 'I hereby cemfy the above stateme is are tore,correct,and complete./� s I aidiaI
Address a meat(matend sleet.city,Mee.and ZIPm&) / \ Adiessor vexed lw--.- lag imrmleraises&oh'.s'ele end r-cods)
- •ASSESSOR USE ONLY '- __, ' ASSESSED LU r..'111O61FSr_AD VALUE ;_I NOtr YALIUENTIAL et f )�7 /'t s,
Land not exceeding one(1)acre Immediately (I) ;r f.ao L �1-r�)\_,l
srurountlmg residential improvements
Other land (2) VIM 0`9 2019:
Total land pia 1 plus fine 2) (3)
Residenlial imp.uve nerds or Dae9ing (4) • / Yill
3 1s < . z ' -
annually assessed mobile I , 7 -lmm •
, _ Y
manatacarredhome Gangs (5) Ile INTY AUDITOR ic4, -
GIBsoN
C
Other rprovements (6) a&`F �1 �`r .
Total Improvements(lie 4 rhroogh line 6) (7)
Total value lane 3 plus line 7) (a)
I hereby certify the above is true,correct, Signature fir Ate.. Dora acted(crab dax 1�)
and complete.
`eritflg amen-Signature cAudta Dee Wed(moah,day,)ear)
- _ - - i STANDARDDEDUCTIONALLOLYANCE - _
20 pay 20 I c.se of 60%of the assessed vbue of the homestead or 245.000.
a- the sum of the deductions povrded in IC 6-1.1-12 to a mobile home S
tit 1' asses as or to a manufactured home that is not assessed as Taal properly may
(1 of the nrrbde home or manufactured home. C
of r •
De2 car lc?
ON: -Carty/ ,r3aSmmped Copy-Tmyayc
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