Homestead_Norrington^,n � S �DARD / UPPLEMENTA DED T OM` � � � � YE�
FORM �
� • StatBFOrtn5d73(R72/6-09) HC��
5 r Presaibed by Ue Departmerd af Loml Govemmerd Firenca FEB 2 7 2013
� wsrnucnoNS se sn � r�� m.0
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. e revarse e or ug ms rons. .
i(We) V certify that I(we) ocwpied as my (our) prir�cipal
place of residence or am (are) b ng e following desCri6ed al property for which a Homestead Property Tax Standard Deduclion is hereby daimed
under conVaG on the date this applintion is filetl, (date o/filing):
��I(We) own ❑ Fvn (are) buying under recorded contract
Am (are) entitled to occupy as a tenant-stockholder of a cooperaWe housing corporation
� Have a beneficial inlerest in the Ws� or [he right [o occupy the pmperty under Ihe tertns of a qualified personal residence Wst
•• • •
Name o/ daimant (legal name) . '
So�ISmrtiry
Sodal Secvrily rwmbr M daimant's spa1sa (last firo Gg'rts) Drimiers Gcense / idrntifiration / ONer rvmber Iswmg Stata
of da'vnanPs spousa (WS! (rve dlgds)
• ••� �
If buyuq on oontra4 Fee Simple ownels rame
Reco�ders oRwx where mnhaG is reowde0 - Recard numCer Page
. . � • • � • •
Counry TownshiP Tanng distrid (all: fown. townshiG)
ParreJ numher Legal desaiD� Is U�e p�o erty in question:
' I prope.rty ❑ Mnua�y ass�setl mod'k home (IC 67.1-�
H any portion d ihe rnsdentlal smicwre «U�e la� not exceedinp ace (7 � acre ihat immediatey su that swau�e iv useE m pmaum incon�e, aeacribe the use and portion
u� ma a��m uoraea m woauce �.
alo--/�-/8-'y6� O 8" �'�O%
-.. . , : . .
Counry Trnmship � Cw�ry Tovmship
I hereby certify ihe ahove ststements are irue, cortect and complete. Si na re o�daimant �
Q.
PtlC (numDer and street, city, slete, antl LPcade)
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Land not esceeding 1(one) acre immediatety � �vi �.,y ��'�-�i�'�N *" �
surroundin residential im rovemenis. ( � -nC' �� _. � � �a�
( ) P�`:�.'�a,�`7�� 'S - .
Other land 2 s;,�,,F-�ti„ �:�
7atal land (line 1 plus line 1) (3) .
� �_�?.,�`°� qn .. ���''�,�'$��.,,,��ts�'
Reside�rtiallmpmvemenLaorMnualty �ilin9 (4) .�c,2�,���-Ct.r-�T?A�c ?'v�c
Assessetl Mobile I Manufactured Home 9 �..� $�t�"3a-�E� =�i`q„Y`iY
Gara e (5) -�r. }�ifi�-k�.'"�`'�s�,.�3�:k�,a�`,�`..
Other ImDroveme�rts (6) �'�'��?'�+�� :
Tofal Improvemenb Qine 1 Nrough Ilne 6j (7) '
Tofal value (Ilne J plus line 7) (8)
I hereby certify the above is We, correct, Sigrawra ot assessor . Date agneC (montn, day, year)
and complete.
VaifyNg actim - 55nawre of Auditor , . - , , ' • . . , ' D�te si9�ed (rtwn1A, tlaY. l��)
20 pay 20 Lesser of 60% of Ihe assessed value of the homestead or $45,000
NWwil2cfaMUg any otherprovision, Ne wm ollhe detl�.ctbns provided in IC 57.1-12 [o a mo60e home Nat k $
rot essessed as real proparry w ro e menufactured Irane that 6 nof essr.ssed as ieal ryoperry mey rrot exraed
onehaH(12J o/Na assessed valueW Na mobde home ormanufaGUrad home.
Sigrianue of Nditar Date si9neC (rtanfh. daY. Yea�