HomeMy WebLinkAboutHomestead_MathenE
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
._ STANDARD / SUPPLEMENTAL DEDUCTION
ram Form ( 6-09) FC7 U
Prescibed by t he Depa rtment of Local Govemmed Finance FILED
INSTRUCTIONS: See reverse side for filing instructions.
APR 1 v 9AI)
CERTIFICATION STATEMENT
C
I (We) "13'
certify that 1(we) occupied as my (our) principal
place of residence or am (are) buying tAe following described real property for which a Hom
perty Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, G IBSO0960051ISM:AU
D ITOR
❑ I (We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of claimant (legal name)
Social SraaLLy
Social Security number of damimrs spouse (last five digits)
DriveYs license I Identification IOther number
issuing State
of claimant's spouse (last five dgicc)
CONTRACT ••r r
If buying on contra Fea SI pie owners name 2 _ Wj�"/t`�t) (�
1
Recorder's off" where contract is recorded
Record nu Page
PROPERTY DESCRIPTION
Coin Township
Taxing d town. ip)
P number I- egal`desorption
Is Ore property m question-
00—CM. y al -cl% '
fuoperty
❑ Annually assessed nrodle home (IC 61.1 -7)
O any portion of the residential structure or the W W not exceeding one (1) acre that Immediately surrowills that smx•Lrre is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY
County Township
nty
Township
I hereby certify the above statements am true, conect and complete.
ESIgnmre f clai ni
Pddress (number and t. c/N. state and ZJPaxte)
D
sb
ASSESSOR USE ONLY TRUE TAX VALUE
ASSESSED VALUE
AT 100Y60FTTV
I HOMESTEAD NON-RESIDENTIA
i VALUE VALUE
Land not exceeding 1 (one) acre Immediately
(1)
�h *`.
sumoundin resfdential im rovemems.
:.- ----
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
�. ^�,
€i�'�+5 Y t":^ -..: �?t3i ._R"+`Aw)a`"�v".�.. -.
Other Improvements
(6)
't
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct,
Signature of Assessor -
Date signed (month, day, yea)
and complete.
I
-
Verifying aeon - Signature of Auditor
Date signed (month, day, yea)
STANDARD • r
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Nawithstandag any otherprovis on, the sum of the deductions provided In IC 6-1.1-12 to a mobre home that Is
$
not assessed as real property or to a manufactured home that is not assessed as neat property may not exceed
on ff R) of A a sled value of the mobile home or manufactured home.
S' re f it
r
Data signysd,(rgonth,
day, r)