Homestead_Fulling ,, - . CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
}�.�; STANDARD/SUPPLEMENTAL DEDUCTION FORM
[— sx); State Fcn,5473(R 1711-16) HC-10 �l
�yela- ri!s; Resorted y the Dawmax of loth Gomment Fawn
INSTRUCTIONS:See reverse side for fli g resbucbou
NOTE Telephone.Social Semaily,diver's lane,stale IdP1d&c5on and federaiiderEdta5m numbers are confidential under IC 6-1.1-12-37.
I(We) .jirt certify that I(we)occupied as my(our)papal
place of residence a am(are) the described real properly under contract for which a Homestead Property Tax Standard
Deduction is hereby claims on the date this - is signed. (date of signature). I(We):
Xikm
l')anL ❑ Am(are)buying under reaxded
(are) entitled to occupy as a tenant-stocklmlder of a cooperativeive housing auporatio.t
❑ Have a beneficial interest in the test a the light to ocaipy the property urda the turns of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
tine ' (hgar 1
Soma Seamy
cod seaaiy/raste) �I .
Naas cadent,spouse(reea1{s \YI
.SomtSeovLy ns ter Sc aads spouse(veer erreOpts) Ddrda / I •I a_. ...stpotee(fastSe d"g11)' Ins -q Sven
r eamelasritymasterJ
-
etuyng co cortraa,rS*Sipeaoelenane MAY 14 2019
Recorders 0503 Were cowed S receded Rooted mute Page
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all County Thcos.
Partn lapel - - 1 is the prudery Fr question
0 Reg gopeny ❑Amtafy assessed monde home e(IC 6-1.1-7)
aanl'port on of the resder4y ensure or me lad na eozedng me(I)we Mat mmedaey anmMs that atraave'e used b erne®.pale,de-YAe the rase and mace
d de property wed b Pods a booa
2C.2.-TS - 1o0-0.0a - .2-5-1 - 001
.1 •_ PROPERTY OV/NED ELSEI.VHERE BY CCAltiANT. .- -_ A - -... _ '
State,Corny,aid Twrst o la claimant vacant a homestead?
❑ Yes ❑ No
I hereby certify the above=Yaemefts are true,correct,and complete. Sri
Address ofsvud(mrm6aaresuet d0:Mt*end2IDLmy �/��a�/yy fi umber 4td my,statr fPwrk
dabnat
ASSESSOR USE ONLY -:t _ 1 -:ASSESSED VALUE ,4 HOMESTEAD VALUE 1-I s+NON RESIDENTIAL
- _ :2 GVALUE c .�1 I e
Land not ng exceeding one m aceexis Immediately V 1
wrnannldalg residential improvements (t) ° '""��:-$°R}`s ...�,
Other land (2) _ r "._-'' `-r -
Total land(line 1 plus One 2) (3)
w i _ t -
Residential Improvements or OreOnp (4) l
annually assessed mobile s ti -r
manufactured home Gaspe (5) - :rr._.4^�I-. t. .-_
Other improvements (6) rzc i L 4 at_
Total Improvements(line 4 through line 6) (7)
Total value(line 3 pins fine T) (6)
I hereby certify the above Is true,correct. Swan dP«�v Des*red(o a date)ea)
and complete.
Venty'ng anion-Signature dMuibr Dam sired(moth day.>ead
20_pay 20 Lesser of 60%of the assessed vaue of the homestead or$45,000. .
NoMt hsfandng any the sum of deductions provided in IC 6-1.1-12 io a mobile home §
Mat is not assessed as al orb a hone that is not assessed as real properly may
not exceed one-has(Vq ed vatre mobile or /hoomme.
Sidman d0adb \ Ifreaortit��
DISnRIRMON:Original-Carey .FaeStampad Tbgale
Pagel Of