HomeMy WebLinkAboutHomestead_Marshall (5)"'n CLAIM FOR HOMESTEAD PROPERTY TAX FORM �
?! STANDARD/SUPPLEMENTALDEDUCTION
a� S�aeeFOrmsa�3(aizls-w) . HC10
�O � Pfescribed by Ne Deparimenl of Local Govemment Firence � .
IIVJ 1 KUG 1IV/VJ: J88 IeVBBB SIOB !W 011lly 105(NL00lI5.
1
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I(we) 9t' certiry that I(we) occupied as my (our) prindpal
place o( resi nce or am (are) �ng the following described real properry for which a Homestead Property Tax StanAaW�Oq(�{ytio{yiy bereby daimed
under conUad on the date Ihis a plicaUon is filed, (date ol fi/ing): U t l. G a c u �[
❑ I(We) awn ❑ Am (are) buying under recorded contract C.�_
❑ Am (are) entltled to occupy as a tenant-stockholder of a cooperalive housing corporztion
� Have a beneficial interest in the wst or the right to occupy the properry under the terms of a quali(ed person s' �1�StAUDITOR
•• • •
Name of imanl (legal name)
Sodal ' rvmiher of ' (lazt frvs d'giS) Drivels Ikense I Identl:Kation! Olher Issu'vg Sate
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Nameot i'sspousa(legalname)
Sodal Seariry numbel of da'imanYS spdrse (last five digds) Drivers license / krntifintion I Other num6er Is,w'vig Sta's
! o,����=s����uh,.ed��, .
. .-. .
If DuyinB m oontract. Fee Slmple ownd's name
Reco�ders ofFce where mnvaa is remrtled ' ' Remrd number Page
. . � • • � • •
caunry � rmmship raring aisu;a (rih: ro»n, rownsNa)
Parcd numher I tlesaiPtian . Is Ne pmperty in questian:
�Q,/Vyy.�Ji.d g ❑ Real property ❑ w0y asussed mod'le home (IC 6f.1-n
tl any portion W Ne fasiden�Wl strucwre or ihe IarM not exceedirg orre (1) aae Ihat unme0iatey surrou�MS that sWCNre a usetl W produce income, aesatha the use and poNm
m me wuaem �mraea m aoa� �.
�.1�-(4-IS- 403^ D00.131-Oo�l
-.• . ._ . .
Counry To.mship Caunry Toxiuhip
I hereby certity fhe above statements are W e, corteU and complete. S�ippauua o1 daimam �
2'
PdOress (number and shee4 ml: �te-, Tard LPoode) - �
So�..}t� Ja�-t�s.+„ S�1�rc• c,K(GnJ C`. xH �/ (040
•" •
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�i . �
Land not e:ceeding 1(one) aue immediatety � �v-'F'�„�'z�.��r��°�' .. �
surroundin resleen6al im rovements. ( � %� �`" .,?+ . .��� w
�:�
'.�,�; =rs, `�
Otherlantl (2) ' ;,,.�. ,_�'�,�g,-t
Total land (lina 1 plus line 2) (3),
";�`�2�'$ ���f.�'.�3'X�c'�.'��'�'.�
ResidentlalimprovementsorMnually �Ilin9 (4) ;� i����°k�#�{,,� 4� -
Assessed Mobile I Manutactured Home .Garage i5) '�$#'�{.�'�.�-���#'� �}^.&�%2- Y4T�
:L�- .i si .._- �k. �4.'i�Yh �+�Y�}
. . � . ,��e{-�+'-,-_` .
OUer im mvements (6) . '�a �` ?'n`"'�`�`.
P t.!,°' •n?a'.�'
ToUI impmvemen� (line d through Ilne 6J (7)
Tatal value (Ilne J plus line 7) (8)
I hereby certify ihe above is We, cortect, Signalure of Assessor . Date signed (rtmnfh, tlay, yna�
and tomplete.
Veilying ection - Signature oflWCtw Date signed (�N. �Y. Yea�)
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20 _ pay 20 Lesser of 60% of the asseued value of ihe homestead or E45,000
NoMtihslanEing enyWherprovis'an, Ne aum o1 the dedurlioru provitletl in IC G7.1-72 to a rta6�le fprtre Nat is $�
not essesseC es real property wW e menWaclured Irome Wt is not assessed as real properry mey not exmed - '
ona-AeH (iR) 01 the assessed ra/ue d Iha mobrle hwne w manufedu�ed larnc.
Sigrature of Autlitor Dete signeE (monN. daY. Y��