Homestead_Parker (7)"'" CLAIM FOR HOMESTEAD PROPERTY TAX pORM YE'�
STANDARD/SUPPLEMENTALDEDUCTION
S stateFOrmsa77(a�z�sas) , HC70
�� � Preuli6ed by lhe Departmerd M Local Govemment Frmnce
INSTRUCTIONS: See reverse side Ior filing instmctions. �
� I(we) � certiry Nat I(we) ocwpietl as my (our) prindpal
place of residence or am (are) buying the following described real property for ich a Homesiead Property Tax St3�rd8)edu�l�¢,is hereby daimed
under contrad on the date ihis appliralion is filed, (dafe o(filing):
❑ I(We) own ❑ Am (are) buying under recorded contract C.'J.n�
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperalive housing corporetion
� Have a benefidai interest in the wst or the right to occupy the property under the terms of a qualifie�($g@ql(y�91pMYX iq1gDITOR
•• • •
Neme of t I nartre)
Sotlal Security rnimC� of daimanYs spausa (last fire tligtrs) Drivers Gcense / kenti5catron / O�her number Issuug State
o( daimaM's spouse (WSt (ne dgittJ
• ••� �
It buying om m�tract, Fce Simple ownefs name � .
Recortlefs ofice wlrere mntrsct a remrtled Recdd number Page
. _ � . . � . �
�n Tamship Taz'vig Ois 'G ' townshiP)
P num6eIr /'(�� {� LegaYldefsafi0.�l� Isihepmpertyinqupslim:
��� (� I��l� �V Oci,-iJ p� 17�7enY ❑ MnuaDYassesutlmobilehane(/C&f.f-n
�M a�ry portan W ttre re�den WI strucwre or Ne WM rwt exceed4g me (1 � aua Nat munetliafdy surtou s Ihal strucWre is used W protlun mmro, Oesrnbe the use aM porUOn
ot ihe P�PaM uhTaed m poaure inmme.
-�• • � : • �
Caumy Tv,mship Cwnry TwrtrsAip
I hereby cerlify ihe above 5tatements afe We, mrteU and oomplete. Signawte ot Uai �
`�
MEreu (number aM sbeet, dry, slate, aM ZIP code)
� ' � .� � -c�-.� � �/7E�v
,. , . . .� . ,
.� .. '
=..3 n ,s � .��-
Land not exceeding 1(one) acre Immediatety � ��� y����$,; �� t.,;� s.�"w
surtowMin resitlential im rovements. ( � ::..�e�.F,. �,a"tp� y�xt.. �}: `
Other land . (2) � �..��:'��'�� ��
;.�-.,..�'--:SSg�.;�: �.
7otal land (line t plus line � (3) �
µ���.p+5. .. i " -.i`�[ :,--
ResidenualimprovementsorMnualy �Blling (4) �th.��?:g_ ���y�r�
Assessed Mobik I ManuFactured Home Gare e x`''�"j2;� � ti'�' �':
g �5) tz':�xS ��:C`'�: ���".'u^S.i-,`��.Y'�..,,-�--•-'
�s; �„4- ��i�*`�;�{;'
Otherimproveme� . . (8) � _"a,.-*;g���+..r'�'Yy.�'
Total improvemenh (line / Nrough!!ne � (7)
torai vaiue (llrre 3 pl� line 7) (8)
I hereby rertify ihe above is true, corte[t, . Signature ot Pssessor '' Date signetl (mmN, tlay, ysa�
and complete.
Veitying aUion - SigriaNie ot �tor Date sgned (monN, Eay, yee�
• � . - � � � • �
20 _ pay 20 _ Lesser of 60% of Ihe assessed value o( Ne homestead or $45.000
NoMitM1sfarMbg eny otherprovision. Ne sum o/ the detluctqns pro�ided in IC 6-7.1-f 2 ro a rtaMTe frorrre thaf is $
rwt essessed es ieal poperry or fo a rrenuleCUred homa Nat is nof assessed es real pmperty mey not e+ceed
eM(121 d Ne assessed value oflhe mobde home wmanulaGUred hortie.
Sg ol Date V /�Vay � l/