Homestead_Etolen CLAIM FOR HOMESTEAD PROPERTY TAX I FORM YEAR
ice' i' STANDARD/SUPPLEMENTAL DEDUCTION 2} HC10
.,� ) State For-.14'3,RI),1-23i
�� Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE Telephone,Social Security,driver's license.state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) , ' . b (.-% certify tnat I(we)occupied as my;our)principal place of
residence or am(are)oayNg the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed. /O_P3 (date of signature) I(We1
I ['Own CI Am are buying under recorded contract
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
I 0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust •
0 Am(are)the shareholder,partner,or member of the entity that owns the property
If Buying on Contract.Fee Simple Owner's Name
Recorder's OHice''Ahere Contract is Recorded j Record'Number cage
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PROPERTY DESCRIPTION
County Township "axing Distnct(city town r.: ^iPi `/
st°11Csio
G�bso►1 v L—d erw` c 1/40 �s0 6' n
Parke
dumber Legal Description Is the property m question �� .C/��
6—I --0?. 'to'—O w, r3 5 -O. ' Real Property ❑Annually Assessed Mobi �111r�� 6,-
If any`poNonlof the resdential structure or the land not exceeding one(1)acre that immed.ately surrounds that structure is used to produce income describe the u r
of the property utilized to produce income y'-1
/G
40,,p , 7
PROPERTY OWNED ELSEWHERE BY CLAIMANT
' State.County,and Township Is Claimant Vacating a9mestead1 \***".---)\-----j
-
Yes 10(NNo
a•na^t t
I hereby certify the above statements are true correct.and complete
Address_' '--tact)number and street city state and ZIP code) Address o ilacated Homestead if any(number and street city.state.and ZIP code' I
I • S r r vice tz. 74%) 447610
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
�Surrrounding Residential Improvement _
Other Land (2)
•
Total Land(line 1 plus line 2) (3) ,
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I ,•
Manufactured Home I
r Garage (5)
Other Improvements (6i
Total Improvements(Line 4 through Line 6) (7)
j Total Value(Line 3 plus Line 7) (8)
i
Signature of Assessor Date Signed(date month.year)
I hereby certify the above is true,correct,and complete.
Verifying Action-Signature of Auditor Cate Signed(date month.year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed vale-• a homestead or S48 000
Notwithstanding any other provision.the sum of the deductions provided in IC 6-1 1-12 to a mobile home that S
is not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed one-half(t/2)of the assessed value of the mobile home or manufactured home
Signature of Au for Date Signed;month.day year)
DISTRIBUTION' Original-County Auditor File-Stamped Copy-Taxpayer
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