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Name of daarnnt's spouse (legal name)
Social Security number of claimant's spouse (last five digits) Driver's ficeriss I Identification I Other number Issuing State
of daimam's spouse (last five drglls)
CONTRACT ••r
If buying on contact. Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township
TexGg distriU (rity, Town, township)
G I C)
w fy -F-0
Parcel number
Legal description .7 S SE,
Is the property in question:
n
T — (' % cf.S 6 A
® Real property ❑'Annually assessed mobile hone (IC 6 -1.1 -7)
If any portion of the residential structure or the [and not exceeding one (1) acre that immediately surrounds Nat structure is used to produce income, describe the use and portion
of the property utilized to produce atcome.
PROPERTY OWNED BY
County Township Caumy Township
1 hereby certify the above statements are true, correct and complete.
Signature imam D
Address (number and street, city, state, and LP code)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE I HOMESTEAD NON-RESIDENTIA
AT 100% OF TTV I VALUE VALUE
Land not exceeding 1 (one) acre Immediately
surroundin resitlenti.1 improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwellin.�5
g
(4)
- �ti fit, +w,s11st
�-
Residential Improvements or Annually
_4
Garage
(5)
'a`-.' -"
•Y•Y' w.����.yT
Assessed Mobile I Manufactured Home
Other Improvements
(6)•-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 jolts line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
verifying action - Sgnature of Auditor
Data signed (month, day, year)
STANDARD • r
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Norwithsrardag any oherprovison, the sum of the dedursow pro uled in IC 6.1.1-12 to a mobile hone that is
$
not assessed es real property or to a manufactured home that is not assessed as reel property may not exceed
mehaff (12) d the assessed value of the mobile home or manufactured home.
Signature of Auditor
Data signed (month, day, year)