HomeMy WebLinkAboutHomestead_Hornby (8) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I
F_•. STANDARD/SUPPLEMENTAL DEDUCTION FORM Sate Form SC73(Rt5/S14J
- '• Prescribed by the Department of Local Govermxm Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone.Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
. - •-l" :. �CERRTIF�ICA11ON STATEMENT . ���^^^���,,,
I(We) ice''/riL!�g=! �t!4T� certify that I(we)occupi-c m )ou i princi I' -'
place of r --nce or am(are)buyiryj(k toll•/g des j-• real pr �ndr co ?act for which a Homestea• 1 o•- '‘ T.' >
Deduction is hereby claimed on the 15 te this- plication I signed, (date o/signature). I(We):
0 Own. 0 Am(are)buying under recorded contract. MAY 6 2011
O Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing c ration.
O Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal idence trust.
O Am(are)the shareholder, partner, or member of the entity that owns the property. `, a
4,77 !
1/1. I
`;
If buying on contract,Fee Simple avmer's name
Recorder's ofSce where contract is recorded Record number 1 Page
3a�c '- bEia sr: t 71-.712-
s PROPERTY DESCRIPTION -__t_. - �.;-,'-° Z .„"'3
County Township r+ lining di (city,town ownsN
k. i / •
Parcel number Legal description Its the pent'in question:
e //, �/' e • , ',OO. —oA x/ Real propeny ❑Annually assessed motile home(/C&t t'.7)
If any portion of the reside'nttital—• • re or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and potion
of the properly Utilized to produce income.
PROPERTY OWNED ELSEWHERE By CLAIMANT
Sate,County,and Township Is claimant vacating a homestead?
0 Yes 0 No
^ /t 6gnaturp of claimant
I hereby certify the above statements are true,correct,and complete. /,-!)l/
Address of mmad(number and=reef,ay.stave.and Z/Pcode) Address of vacs da um�t,my Sate,and ZIP code)
7 9 se / r z v// 5/7.5/
Land not exceeding one(1)acre immediately I(1)
surrounding residential improvements
Other Land 1(2)
Total land(line 1 plus line 2) I(3)
Residential improvements or Dwelling (a)
Annually Assessed Mobile I
Manufactured Home Garage (5) •
Other improvements (6)
Total Improvements(line a through line 6) (7)
Total value (line 3 pits line 7) NO
I hereby certify the above is true,correct,
Signature al Assessor Date signed(mornA dog year)
and complete.
Veep.•g action-Signature of AUd:tor Date signed(month,day,yea)
S T D DEDUCTION ALLOWANCE'-? `^_:'e'- f - 4 v 1
20 pay 20 Lesser of 60%of the assessed value of the homestead or Sa5,000
Norsnthstanddrg any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as mat properly or to a manufactured home that is not assessed as real property may
not exceed one-half(1R)of the assessed value of the mobile home or manufactured home.
Signature of AUdtor Date signed(mono day.year)
DISTRIBUTION: Ongsal-Courtly Audtor,Fie-Stamped Copy-Taxpayer