Homestead_Baumgart —w
aF•"t CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
J% STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sate Form SN3(R15/S14) HC10
;'- Prescribed wax Department of Local Government France
INSTRUCTIONS:See reverse side for filing instructions. r
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37. 1/2
-CERTIFICATION STATEMENT' C - - '�a/'/fi
--
I(We) / / F "/ l . / certify that I(we)occupied as my(o )pri
place of residence or am(are)buying the flowing described real property under contract for which a Homestead Pe-rty Tax Standal
Deduction is hereby claimed on the date -s application is signed, (eSeG(si.£�: .•I(Wt):
Zr.-Own.Own. ❑ Mn(are)buying under recorded contract. • `"'JJON CO0. '7,0�
❑ An (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 7)',q
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence tl�iQ/TDR
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
-_
If owing on contact,Fee Simple owner's name
Recorder's oboe where contract is recorded 1 Record number Page
x r. __.. '.'L. _ '1.:- `-Ss•- , '-PROPERTY.DESCRIPTION - _S'=a a t.<2; Y "_'".`_':'
Township Taa hii/d/diii (city,to township)
AI Pa. number,d tl N Leg desaipten Its the WOpsny in'71( guesheg
' j� lY (1) oti immediately property ❑Annuah assessed mobie hone(IC 6-I- )oot g an)A/!aor.of the reasdergal=whim or tie land and exceedsig/Lone(/(1)aaoe('WCt v nedtt y that stature m used to produce income.describe the•-Se and pot
of
tie'
uttered to produce income.
0%-/7- €j?aA- 7/- j7/-Dec
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,County.and Township Is Claimant vacating a homestead?
❑ Yes ❑ No
Signature of clamant
I hereby certify the above statements are true,correct,and complete. Qitiii. 5/,�{{JT�t/+��-ygs1.R 5yp."1��/J-I�OA�'1�t/G" .J
Address of mrsaa(number and street oty,state,and ZIPcode) Address of vacated hmeSe3J d any(n and Saeet,ay,state,a • P )I \Al
'-LCJ . IJZ S. YYIC,:n -5F. A- Bra(c --ti enfri£
Land not exceeding one(1)acre immediately '(t)
surrounding residential improvements
Other land 1(2)
Total land(line 1 plus line 2) 1(3)
Residential improvements or Dwelling ((4)
Annually Assessed Mobile/
Manufactured Home Garage ((5)
Other Improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Sgt a of Assessor Date signed(month,day,year)
and complete.
Vsifyvy action-Signature of Auditor Date signed(month.day,year)
1v .•LAS':$is _aR s=_Sxi
$.�.1=3�:�fi- ; -_ = : ���:sTANDARODEDUCTION�ALLOWANCE_�_ - `�i.-�B�
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
Notwithstanding any other provision,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(12)of the assessed value of the mobile home or manufactured home.
Signature of A.ddo Dale signed(naCly day,year)
DISTRIBUT1oN:Original-Corny Nd.tor.Fie-Stamped Copy-Taxdayer