Homestead_WestCLAIM FOR HOMESTEAD PROPERTY TAX YEAtt
- CREDIT/STANDARD DEDUCTION FORM
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Prescn'6ed by Ihe Oeparlmerrt of local Gwemment Finarxe �. ON
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INSTRUCTIONS: See ravarse side forfiling insWc6ons. SubjeCt kq�(lpal �cc,gptance for iransfer
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I(We) oowpied as our prindpai place of residence Ne following described real property fw which a H erty T� i(j����rned:
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L7 I(We) owned ❑ Are buying urMer contract Parcel �+
�Have a benefidal interest in the entity that is IiaWe tor the property taxes on ihe property and that owns ihe property or is buying under a crontrad.
Ii buymg am m�traq, Fee Simple owneta rmme
RecadNs of6ce whare corrtraa is recortled
Couniy I Tpmship I Tarin��7i5trict (ci(y,Qown.
Recwd number � Page
Pafcel number Legal descnP�t,��7 n'��T / / Is ihe property in quesUon:
S(/1 �c. �O �� �( ❑ Real property ❑ Mdzle Home (IC 6-7.7-n
tt arry portion of the residemial siruGUre a iha IanE nd ezceedirg orre (t ) xre Ihat immediately wrtounds Ihat stnicture is used W produce inrnme, dewibe t7re use and ponion
of Na properry uliGzed b produce inmme.
a(o-/d - 0�-�20l, 000. 3 y7-va-f�
Counry � Twvnsnip
I hereby certify !he above statemenfs are We, correct and complete.
s7ee4 �ily: stete, end ZIP
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LarM not exceed'rg 1 (orre) ave immediatety ``"�' :' i � �� .. . ., t` ..= . �
surrounding residential improvements. (7) . -� '`fi �ti? '
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Olher land (2) `'`: y�: ..>-:;
Tdal IarM (line 1 plus line 2) (g�
' =..:e"�';-. ,�. ''.-. ' -
Residenfial improvements or Mnually �d�� (4) . -. - �'� � -
Pssessed Mobile / Manufaccued Home . � . -
Garege �5� " - . � ' "
's. r
omer improvemena (6) - � -
TUaI improvertienis (line 4 through Une 6) �7�
TUaI value (line 3 pfus line � (g�
I he�eby ce�(y the above is We. COrt2tf. and Signature otAssessor Date signed (mmN. daY. yea�
comptete.
Vaifying action - SignaWre of Auditw Oate signed (mm(h, day, yea�
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PaY 2o— q5,000 for 2W7 pay 2008 42.000 for 2010 pay 2071
Lesser M 12 qq.000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead ValuaSon S
a 43,000 for 2009 pay 2070 40,000 payable after 2072
SignaWre of Auditor Date signed (manth, day, yea�