Homestead_Hipp (2) ,` t CLAIM FOR HOMESTEAD PROPERTY TAX YEARE v. STANDARD/SUPPLEMENTAL DEDUCTION FORM n_ '
Stale Rom 5473(R1711-15) HC10 20l
Prescribed p ere Decamst d maxi Government France
INSTRUCTIONS:See reverse side for tiring instructions
NOTE:Telephone,Social Secvix drivers Ecense,state idodktaion and federalitlum&'amn numbers
are confide:ter under IC 6-1.1-12-37.
I(We) nut, t • certify that I(we)occupied as my(our)principal
place • a am(are)buying th aminodam real property under contract for which a Homestead Property Tax Standard
• Is h ieby claimed al the date this appgration is signed, (date of Signature). I(We):
fhm ❑ Am(are)Guying under recorded contract
(are) entitled to occupy as a tenant-stockholderof a cooperative housing corporation.
❑ Have a beneficial merest in the trust a the right to occupy the property under the terms of a qualified personal residence trust
❑ Arn(are)the shareholder, partner.or member of the entity that owns the property.
Name at
nays)
HiiL• ��
Name d
tT 1
• CONTRACI'xECO J . _ . _ .
If twin]on oxeey Fee Sonde comers nine
MAY 15 20 9
RewUeds dice were mrtrffi a recorded Rove number Page
a .
ar
pan: - 1 ll
Legal dmc .am • b eeryw nsocn
Real«oPcb 0 Avcalyassessedmoblebae(7C6-1.1-n
rep wratadme re90etal strudsse«ve tend«s enseMpom(I)eve eatenme.er.y structure is used to mosm atone,dmme Me use atpatm
of me pc eny dazed b produce brave.
% r g -3 6 -yvo3 - coo. S9, --c 09 .
- - PROPERTYOWNEDELSEWHERE BY CLAIMANT- I{ (. . . ..
SUM, and tl Township _._ IS✓ \ Vacating a homestead?
• Yes ❑ No
X 5a a+addarta[
I hereby certify the above statements are roue,correct and complete.
1_J e•.
•
Address dya md(«lmbc end Mee(ch; U.fe m s and IL whew .A. 1 ten , saaeL
,and Z�wds.
nett
not
ASSESSOR USE oNLY 1:_-, I- ASSESSED VALUE__ 4..i. HOMESTEAD VALUE ..,I NOtU-RESILUEDENTIAL :'i
VA
Le �
Land t exceeding one(1;acre immediately : - � , " e �smnound in residential improvements (1) ,b a 1. t ri veto-4
Other land (2) 244;--. ..,_
Total land(line I plus One 2) (3)
Residential ease ants ce Dwelling (4) _ _ -..,f=_±:..,.: ,
annually assessed mobile I
manufactured home Garage (5) OZ;# x y-
Omer improvements (5) s z "'S.:,'L r , - _'_ '
Total bnma..un.ms(lire 4 through line 6) (7)
Total value Woe 3 pea One 1) (e)
I hereby certify the above is true.correct, Saguaro dAseassar Des sigrod(aaYfy dace level
and complete.
Venting ether-agneese°Mda Date sore,(morel,day,lee)
20 pay 20 Leiser of>..., . the assessed vSue of the homestead or$05,000.
NoMehsiarmSing. provision,m the deductions provided in IC 6-1.1-12 to a mobile home f
that is not ease- properly, t ._..red home that's as real property may
ce atlT1 , .
•=,tie9
Dngsel-CaaayMrta«fie- reed Cop-Tmmayc
Pagel of