Homestead_Jones (2) c W CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
e.
s- STANDARD I SUPPLEMENTAL DEDUCTION FORM
V, Stab Form 5473(R1711-16)
Resorted by tie Deportment al Lod Goverment enemy MI0 20 lot
INSTRUCTIONS:See reverse side for fling nstn#ibns.
NOTE:Telephone,Social Security Chart icerne,state idenfaca:ron and federal identffication rumbas are cortAv T.del under IC 6-1.1-12-3
I(Vie) •el CA L .0 O rt, e certify that I(we)occupied as my(our)principal
place of ence or am(are)buying the following described real property under contrail far which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this appfiation is signed, (date of signature). I(We):
Own. ❑ Am(are)buying under recorded
(are)entitled to oaupy as a tenantstodcholder of a cooperativvee housing
ing corporation.
im
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the properly"
V bang cn cannot Fee Shupe carers name I 1 I.1
RecordYa oEm Wive Meted is resorted Rend nabs Page
SEP 3 2019
' I ," PROPERTY DESCRIPTION " - -
,Crib \ :.- -Taeaatp /I/ T itG 'rt WmVa➢1
Paad �',c I®EftNp/cCl AUNtea descriptonTYrybwemaa •
rpertr 0 A'vady assessed motto are(IC 61.1-n
II any pawn d ors ramatal where a me laid as edxe6q one(1)ace that immeSa drymce bused to Boats income,desalt*the use and potion
et ere procedy c&ed to prate acme.
26- 17 - J Z_Z (..l - 000 S ZS - b ?? .
- -' - - ,{, PROPERTY OWNED ELSE:VNERE BY CLAIMANT - - ` "
State Conti end Township - Is d3IIrnall ' a homestead'
El,Yes o
oil
I hereby certify the above statements are true,correct and complete. �i
Address d coact(rxrvmrea s5ee(oiy.stab,and ZIP cock) - - p^•.-.fvneshad W vahued.ah+�e,WZIPcx6)
tt . S N . 'Ville-i — `d- 663�
• ASSESSOR USE ONLY .' ...I. -.ASSESSDVALUE_ :_' HOMESTEAD VALUE°_-.j'-�1 NOt:-RESISIDENTIAL
Lend not exceeding one(1)acrerUnmanliery ;T -
surrounding residential improvements (1) > .Y ..-
Other land (2) lke-1 , r,�'43 :._.>_. ,-.
Total land Dine I plus fine 4 (3)
' x
Nnp �
Residential Improvements or oae (4) -- -. a- _ _
annualy assessed mobile I _1 r
manufactured home Garage (S) .7l ;,„{:4 44X7.7"7:"47i'l-T3-I-O#rL4:'
4 . - rtLOther improvemem (6) s .'
-L
Total Improvements(lure 4 through line 6) (T)
Total value (line 3pita lnel) (9)
I hereby artily the above ire true,coral. ciAssessor Da sited(enti da)5 yeah
and complete.
VabYg apron.Signore ofA:#mr dap Wed(man day,Yea)
20_pay 20 Lesser of 60%of the assessed value of the homestead or S45.000.
NotuitstanGmg any r• - the sum of Use dectuctans provided in IC 6-1.1-12 to a mobile home $ •
Nat is not assessed al w• or to a manufactured home that is not assessed as real properly may
not exceed dlPhal( of.r-assessed�1 vaalu of the Caaad home. )))
Spare ofAudmr ` yf ��,(/ Date d (rvCy )�
es1R fnON:Orlphmd-Casty Az ,,as-Stamped d Copy-twc.yes f•/C5� t^}L` ?
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