Homestead_Allen (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
E.dr ,;.e STANDARD/SUPPLEMENTAL DEDUCTION
F ""-'- ., Stara Form 5473(R17/1-15) F{C10
` hrs./ Prew@ed try me Depaanva of lag Cbvetrtma Fiance
INSTRUCTIONS:See rename side for filing i,Sruceons
NOTE:Telephoe,Socal Seadht drivers'cense,state idmfdo.Yon and federal it:Oration numbers are corthrierdal muter IC 61.1-12-37 a-••e
I CERTIFICATION STATEMENT • Bp■1-y/'. 1,`
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mkt)L I 4IV i7 t Ql I -a /P/2) certify that l(we)occupied as my(.1 ."•
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place of residence or. (are)buying the following described real property under contract for which a Homestead Property Tax Standard .1
Deduction is hereby claimed an the date this application is signed, 4'24- 2"9 (dale of signature). I Me):J U N 2 4 2019
Own. 0 Am(are)buying under recorded contract
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the taut a the right to occupy the property wider the terms of a qualifed personal residence ti( 4 j;
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❑ Am(are)the shareholder, partner,or member of the entity that owns the property. �p�...
• NTY AUBI TOR
- - CLAIMANT'S INFORMATION - - - --
al cheated papal/mute)
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Names espave(leyalrar.e)
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aN.araM am+d/amOaJ ..1/-1e//
0borne ona+maft Fee Staple amers name
Remits ode Were oamact le recorded Renard comb, Page
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- r •I'' - PROPERTY DESCRIPTION - . ..
Case q Tcemtip Twig7d�rtict(ray,(/lam,,raembp)
c7- 1 Nun— I�s�s l i or am Ys.-s// / tom/
Par>d acne, Legal dsaipaat /' Is de qv.
n: Lunen
2/. y�,•/9-Zoo-ODoe /a/-ma5 it property . ❑Aavoly assessed=ab tam vc6-1.1-1)
u any Pam ate red:Weal Mixon or de trod na auetE1g One(I)ace that mmeda'ely saramds ta=mam is used m Produce ktPrna dead*is use and Pala,
of is comely teT¢ed b pan Yam
`. _ - _ )'.. PROPERTYOWNEDELSEUYHERE BYCLA1MANT ..-f{• : .
Sate.Cony,ad Twadtb [�. Is claimant vacating a homeste�
�N /ate✓c-nL - ILA l 672--i /y/f�^� ❑ Yes ❑ No �7(//
BTtmse/ / lea-, irk !
I hereby certify the above statementscoand co are true, red,amplete. / /} /
Address acal-tact(naalaaeN next dry,Ya:e,end ZiPcvck) Address area um vacated heafead,dem VenteradsaeeR oe,sib,end Z�ccde)
4Wz -E S ancA.
-.±ASSESSOR USE ONLY a.'. -`.) ..ASSESSED VALUE ---( ,HO His TEA DIALUE I - NON-RESIDENTIAL -_
"-.VALVE
Land not exceeding one(1)acre Immediately (1) .3z?�� n . .t,.
sunoundmg residential improvementsimprovements -
Other land (2) a-C := F
Total land(line 1 plus line 2) (3)
Resennualrrlial improvements or Dwelgrq (4) - - _-_
annually assessed mobile I - ._-
manutaehrred home Garage (5) z?•",g'--. ,.. .-____:<e
Other improvement (W • z tj., ,-- -C _._
Total improvement(line 4 through fine 6) (7)
Total value (line 3 ph•Gne 7) 03)
I hereby certify the above is hue,correct, re of Assessor cam d (nxrmy day,yea)
and complete.
VelyigJ>mm-sig�ae,a/wiz. Data erased(math der.feat
IiF!(I r-//tP_/YZL I / r La -2 t-1--Zo 19 •
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20 pay 20 Lesser of 6096 of the assessed value of the homestead or 145.000.
Notroehstanding any other provision,the sum of the deductions provided in IC 61.1-12 to a mobile home $
that is not assessed es real properly or to a manufactured home that is not assessed as reaipropeM may
rot exceed Menem(I/2)of the Benaeced vaam of the mobile home or manufactured home.
s t=sEaqu6b . . / Date egos](month. I9
aIV(\A///L/Wf/,I/IW/ .1'�A/Ldigw, - Zy- i 9
WSTRD3UTlON:&idtul-Cony mutter,Fite—Ramped C -Taxpayer
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