HomeMy WebLinkAboutHomestead_Jost (4)p'"" CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
1� STANDARDISUPPLEMENTALDEDUCTION FORM �
Sa:eFwm54]3(R15/Sla) HC10 �
!�� • P�ewibeC q Na Depar.Tent of Laol W.emment F nce ��. 1 T '
INSTRUCTIONS: See leverse sitle /oifiGig in9ruclions. V Us 1 ��� �1
NOTE: Tekphone, Sodal Secunty, tlrive/s Gcense, sta:e iden:Gmafion arM fede2l itlenuSCaGOn numbers are cmfdential under IC f-1 7. I 1•••1
I(VJeJ certiry that I(we) ocwpied as
place of residence or am (are) buying ffie following described real properry under contraa for which a Homestead Pm{
Deduction is hereby Gaimed on Ne date Nis appliration is signed, (date o7signa.0
❑ O.m. ❑ Am (are) buying under recoMed contraa. -
❑ Am (are) en;itled to occupy as a tenanFS;wkholder of a cooperaUve housing wrporaGon.
❑ Have a benefcial interest in the wst or Ne right to ocwpy ihe property under Ne tertns of a quali5ed��p,a�
❑ Am (are) the shareholder, partner, or member of the entiry that owns the pmperty.
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co�.y
o� aauvant Pasr Pre 6vxs1
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ParoN�uri:per legaltlesai�ion " IsYxprope.rynQUes•.ion: I
[�S,Real peopeny ❑ A�n�ah g*e� �e liwie (IC 6f.1-n
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W tne P�DaM �'•T¢ed ta P�uce Nmme. I
Z �O-'� � —3 � � O 4` o00 ✓ �f (� 00 �
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I hereby certify :he above sa:ements are true, cortect, arW comple;e.
�aEmu of � c(numEei arM sueet a.y.5a:e, erd LPmCe)
_ s� 1 E !�l �.., ,/�(�� (�.� 4. iN v)�
Otherland
Todl land (line 1 plus line 2)
ResiOential impravementi or
Annualty AueueO Mobila I
Manu6cNrad Home
Dwelling
Ganga
ONer Impmvem¢nis
Tofal improvemenb (lina < Nrough lin¢ 6}
Totai value (line 3 pl(s line �
I hareby ccrtiy Ne abova is We, cortec4
and complete.
/m.jvg ar.:an - Sg�uLre o1NN.ror
(3)
(G)
(�)
(6)
Is tla"unant vacating
� Yes 0 No
neetm of ram:eo nones:eao. � x^Y (nummr ar�a SbePo. ary. sae.
20 _ pay 20 _ Lewer of 60% of Ihe assessed rAUe ot Ne homes�eatl or 545,000
AbfxiNSfantivg any oNerpmvision, Ne wm o! Ihe tledurtons provi0etl !n IC G1. f-12 fa e mobile lrome 5
fia1 is rrof assesscd as raal property w ro a manW.aCUred hwne Na1 is mf assessetl as real propery may
not exceed one-haH(1/t) ollhe assesmC value o/ the mubde fwrre nmanu;acfuretl neme.
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DISTRIBUiION: Qg�mal-Gwn.yAW::w.Fde-SampMCaoy-iazpayer
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