Homestead_Schnell < FORM
on" CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
: \ STANDARD/SUPPLEMENTAL DEDUCTION OR
Sure Fond sal3(R15/5-14)
S.;„: Prescribed fry de DepaMrent of I_ I Government Finance
INSTRUCTIONS:See reverse side for filing instructions. 1 I
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-1; h i
I CERTIFICATION STATEMENT:6 - .'.: - - ' t '-.I t I-f `--I1
1(We) ,! tilt i. 'V— ' L __ 4 . : , C/ certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the followi described real property under contract for which a Homestead Property nand
Deduction is hereby claimed on the date this application is signed, (date of signature). .4).: j 4 4015
❑ Own. ❑ Am(are)buying under recorded contract. , J
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. p .
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified P 89 i.t-'v 'V.7/777
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
,-
If buying g on contract,Fee Simple owners name
1 Remodels o5w where mntna is recorded Read number Page
r.,, _--_ _._ _ _ _ sPROPERTY,DEBCRIPTION ca,.._ See•»-mss .mss__-.,.A :4A:- t
Townstvp Tarp d9ict(sts loan,toensbp)
Parse number Legal desmiSion Is am pproperty in quest
](,1 Real property ❑Annually assessed mobie home(PC 6f.1-f)
If an ton of the residential =Care or the land not e[[ttW2g one(I)acre that Immediately surrounds mat Srucsure is used to produce income,describe the use and portion
of the property v3¢ed to produce income.
S—/3-A' 3. L500. dI&. acs
PROPERTY OWNED ELSEWHERE BY CLAIMANT
1 Sue,County.and Township Is claimant vacating a homestead?
❑ Yes ❑ No
ISignature of ClaLmam /h
I hereby certify the above statements are true,correct,and complete. �/ _... ' /Kn
I MP
Address of contact(number and greet,mar gate,and ZIP code) U/ Address of vacs' 'cad,I any(number and street al(y state,and ZIPP code)
C�V / LI F c / l rEcjP g (D r r / c./ ✓) li c c-, 1 'lV r
Land not exceeding one(1)acre immediately I(1)
surrounding residential improvements
Other land 1(2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage I(5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line]) 1(8)
I hereby certify the above is true,correct,
Signature of Assessor Date sgretl((month,day,year)
and complete.
Vadryg action-Signature of Auditor Date signed(month,day,year)
r:..'P_- -:_\16 q' ,,-- -STANDARD DEDUCTIONALLOWANCE-a �---s_" ._ '.7-F•j+ '
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545.000
Notwithstanding any other provison,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(I/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(monM,day,year/
DISTRIBUTION: Dogma]-Cam&Auditor,FieSamped Copy-Taxpayer