Homestead_Lloyd CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR I
�_ d s STANDARD/SUPPLEMENTAL DEDUCTION OR
State Fted by the(RI5/St4)
=' Prescribed by d,e Department of Loral Government Finance
INSTRUCTIONS:See reverse side for filing instructions �ppuV,
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 61.1-12-37. I)
:� CERTIFICATION STATEMENT -
I(We) d4 '"I - Se' cemfy Nat I(we)occupied as my(ou II n4
place of • once or am(are)buying the following d 'bed re-if perty under contract for which a Homestead Property Tax Standard 205
Dedu Is hereby claimed on the date this appli -Len is sign- , (date of signature). 11-):
i
❑ •. . ❑ Am(are)buying under recorded contract. GISSON tariff
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. COUNTY
CI Have a beneficial interest in the trust or the right to occupy the properly under the terms of a qualified personal residence trust. VOITOR
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
• _ _ _ _ . -
Recorder's o5ce where contract is recorded Record number rPage
Cow((//=/!/�/ v/� TOMIefJp \el¢ 6tr ( ,1 • tm.,rsny)
Parm`number .on (/-//-f'/y/'I the.ropey in question: (/�/,
•
if ,7./ /rl/ : Real property ❑ Annually assessed mottle borne K6-1-1-7)
If any portion of the residential stuGUre or the land not exceeding one(I)a N im edit suno rids that=Sure is used to produce income,describe the use and portion
of the property,t36ed to produce'morns
off-/9—/9--/oi— 06/ JG/DdG
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate.County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Sign= imam
I hereby certify the above statements are true,correct,and complete. Xf 4G/'-'o'
/ Address of contact(number end street Wye sate.angZ/Poede) / J` of vacated no:nes:ead.d ern(our. raardd srre;coy.Sate,and ZIP code)
/`A\I - i /Ai. ./ -/ -t'e -4 i
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
Land not exceeding one(1)acre Immediately I(i) I
surrounding residential Improvements
Other land (2) I
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) I
•
Other improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month.dog yeas)
and complete.
Vedyi g adcn-Sgraane of Add:or Data signed(ninth,day year)
-. •--<.-.__.y,.� 7.-7"Wry:-STANDARD DEDUCTION ALLOWANCE S fie"-- --•y i ;+ '._ :'r
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 toe mobile home 5
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 motile home or manufactured 17oun9.
Sgnatu a of Parlor Date signed 4.•++-L day.year)
DISTRIBUTION: O,ignal-Gamey Au f:or,PieSamped Copy-Taxpayer