Homestead_Whetstone (5)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Steta Fortn 5r73 (R6 / 4-03)
Reaamed M the Departmmt d Lxal Gmemment Finar�ce
INSTRUCTIONS: See isreres dda for �Jnp iy6ucGy�a
FORM
��e) ` � � , cti � � certiry that on the ts�( M 0
I(We) occupi as our principal place of resi ence the following described real pmperty for which a Homesiead Propertv�BSON �� ��ereby imed:
❑ I(We) o ed ❑ Are buying under conirad G COUNTY qUDITOR
' Nave a benefidal interest in the entity that is liable for ihe property taxes on the property and Nat owns the properry or is buying under a wnUact.
I( buying on contrad, Fee Simple ownefs name
whera canVad is recwded
County
Tavnship
H any portion ol Ne resiAantial sWcWra n Me IarW not axceeding ona (7 �
W the propery utilfzed to produce income.
Is the
wrtounds Ihat
( Record number Page
'�x�_'.�`�='-+��-�"� q`�'>£e:,,�',-i :.•.���u:�,`$��,�.�_:+�ST�Foc�;;i
.t�:,
township)
�
in quesUon:
] Real property ❑ A7oEile Homo (I.C. 67. f-�
�re is used tn produce inmma, desaibe the use and portbn
3 s--�'x`��._"�'-'�fl.?���..n. tiz.',,�"t.y'�y � >�.�..e . � ,.v.+ �.�T-=�.-- „i-... � � -.� - 'Lj «.y.,.
^`� � ASSESSDR�IJSE ONLY i� � � TRUETAX'�ar� ASSESSED VALUE s+HOMESTEAD ��-�- , NON;REStUENTIAL ?
�������.�. ���.�e.�gg�i��j;s���"�.�� �VAIUE'�� AATa100%OFbTN� �rF,s,�"--.VALUE� ��� �'�VALUE,�,.,�V,.� �'€y�
Land not exceeding 7(one) acre immediatety ' ��,�-+�°�..��;�-2".c�i�
suvounding residential improvemenis. ( � :•_ �',- t� ,� � �. `"' `
-� 1 '.. ��,.� �F= 'X�'�R�
Otherland ( � -�",�� �� ;���
2 �
���..���'��'�'�:�
Total land (line 1 plus line 2) �3)
:+� r..+`+-r.'.', .-ti � n'y'?
aK,
Dweiling (4) �_ �q�R' �ml�vr�
�Residential improvemenfs or MnuaDy y . ,�,`� =�
Aase�ed MabOe / Manufac9ued Home Gare e -��,f •��'�'����
9 �5� �..�..�-- ��" ,� s°-zti.s'
�C'?4�^ 3
Other improvements (6) * �+ °'' 'n=
r is ��,..
Ttlal improvemenfs (line 4 through Irne 6) ���
TUaI value (line 3plus line n (g�
I hereby certify ihe above is we, corred, and Signamre W nssessor oa2e signed
mmplele.
Veritying action - Signature o(lwAiwr Date signed
�.=: � ��-� �;ui��v�,�:,�"�'�.��e",.�,;;#�z;STANDARU'.DEDUCTION`ALLOWANCE U`�%+^�}�"�:�„� � �' ��,;;r'.�yj,45�i-�:s���
20 _ Pay 20 _
Le;ser N 112 Homestead
S
vauanon a f35.000
S"greture of PLEitor " Date signeC