Homestead_Perkins CLAIM FOR HOMESTEAD PROPERTY TAX FM
STANDARD rocs STANDARD/SUPPLEMENTAL DEDUCTION
See Form S473(1211/1-16) 14C10
Prescribed by the Department of Lozal&yammers Flute
INSTRUCTIONS:See reverse side brt70y ingruchoni
NO7E Telephone,Soda!Sxvy;drivers tense,Nate idengeorlion end federal Idert qn numbers ere confide:ter under IC 6-1.1-12-37.
• CERTIFICATION STATEMENT
I(We) TiC)4Th Q ear T certify that I(we)occupied as my(our)principal
place of residence or am(are)buying to folbxing described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claims on the date this application is signed. (dale of signature). I(We):
❑ O,m ❑ Am(are)buying under recorded contrail.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest trl the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the sharel-older, partner,or member of the entity that owns the property.
Name at r>biiat(legal came) • •
list!3 1 •
Nana at daaaant's space(terpl name)
ial:astOneAJ c -r- -VJA nS
ranee a claimant's souse WVthgds) Rivers tenser Ild�enteca:co t Oar number a dams ,spasm(Ias are.apt) lasing Sae
aicesl scary n»er)
• 1 �V
a anal)on ocbxt.Fee Share moron name
Recedes ones chore ores s remaaf Remo numbs Page
Toast* Tamp drain(on;ben;benaC)
IbSe(1 �Q-4I(1c SCDIr11
Paul casaba 1egsdaory .m Is erre�Pe�q.1)'b greater o
l l Kea Poverty ❑Antialy assessed etas tame(IC 6-1.1-1)
It eel rcesaa at 0e re90anll muse or se lane net tweet*one(1)ace tat inmaed:Jy sounds eat nine is used b poem ircna,dmab.a the ma a d perm
at the property oared to preen inane
, - - PROPERTY OWNEDELSELYHERE BY CLAIMANT.. -- .
Ste.Carey.end Tonne* Is daknar • a homestead?
es ❑ No
Sigass aataaunme
I hereby certify the above statements are true,correct,and complete.lci (1,- 42. t
pp......a t Manner an:stet eat.slat.and ZIPmdt) v •.,-a salsa t me sd.if al(mnberar greet,city,Sfa,and z�mde)
LIOa(n E hi k- Onk ner- ' ; �l��to &.LI SO , P lessa
-ASSESSOR USE ONLY ?i - ASSESSED VALUE l HOMESTEAD VALUE -,) 7 NON-RESISIUEhTIAL _"'"('
Land not exceeding one(1)acre Immediately 1 s 'Y .e-
surrounding residential blpm O vements
Other land --_ (2)
Y •..
t
Taal land(line 1 plus line 2) (3)
Residential bundeelnents or Dwelling (4) .r---I
annually assessed mobile/ • •
manufactured home Garage (5)
Other improvements (6) cL.::- C- L( JUL 01 _ *,049
Total improvements(line 4 through line 6) (7)
Total value (Ibe3 plus lime]) (a) ( p
e hereby the above is tore,correct. S'mie'a8 aAeaasa 13� '�., it'
NTY Atli
)ITot?
Verifying eaten-Sigiare aAdtr D ajied(ilflte due yet)
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
AbtMShstartang any other provision,the sum ode deductions pmNded in IC 6-1.1-12 to a mobile hone S •
that Is not assessed es real property ore a manufactured home that is not assessed as real propene may
not exceed ore-hal(V2)of the assessed value of the moose hone or manufactured home.
SV9fpf p\ , ere cored(call daY.1s6
DISTRIBUTION:Original-CaveyAUIDx,li9a pit Copy-TwCopy-:Weyer
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