Homestead_Schile�
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� Tawnship Taarig tlis '(�, fown ownship)
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Parrel mher LegalOesai ' I iheO�P W��:
- p� ��� • Real pmperty MnuaCy asse55e0 modle tqme (IC 61.7-7)
tt a�ry ponion d ine residentlal strucNre or U�e WM not exceedug ana (1) eaa Ihat IrtuneCiately surtou ds ihat shuctira is used Io yoAUCa IMame, Eesrnba Ne use aM pation
al ihe P�PeM u0T¢eE to P�uce inmme.
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Coumy Township Counry Townsltip
I hereby certity the above stetements are We, mrrea arM complete. S' re ot iman �
Pddress (num6er aM shaet, city, slate, aM ZlPcade)
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Land not exceeding 1(one) acre immediately s��1�ia,.i�'` t" �'��"'*:�"'��-
sunoundin residentialim rovements. (» �;�2`E�`����`��'� �-=.�--��
Other land . (2) ,_-°+s.'� +4 � ;��r
+::+. ...xe. .
ToGI land (line 1 plus line 3) (3)
Dwellin `+c-�. ,t� +r �.'�- .�' `.�
9 (<) :��,'.s�..� � �. _+n.��•L 3'�-�`��d�_,'
ResidenUal Improvemenb or Mnualty �
Pssessed Mobib I ManufacwreA Home 9 r�.�s'� �^-�n"3,,,�`a�"""-+�Y',��
Gare e (5) �S'rvi.F�xa� ...��. `�-.�''`�s.�='i9.. _
i-'` "; y"}'*�'
:'�''.�!x+'ry. t'{
Olher Improveme�RS (6) _�r;., �t�,_
Tatal improvements (Ilne I �hrougAline � (7)
Total vatue (Ilne 3 Plus line n (8)
I hereby certiy the above is true, cortea, Slgnawre otnssessor oate sgnm (monm, aay, yea�
and complete.
Veifyi�g actian - SipnaNre Wluiditw Date signed (monN, daY. Y��
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20 _ pay 20 Lesser of 60% ot the assessed value of the homestead or $45,000 -
NoMiNSlaMUg any ather provision, Ne s�mW the tletlucfibns prowdtd ln IC 6-f. f-f 2 W e rtro6rle home Nat k $
no( essessetl as real property w Io a manutarlured M+ne thet k nof essessed es real property may not exceed - �-
oneJieN(1R1 d Ne assessed rdhre d the nnbde hane wmanWaaured hortie.
Sig�atun M PLdimr Date siB�eE (monN. daY, l��