Homestead_Woods (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4.m. STANDARD I SUPPLEMENTAL DEDUCTION FORM
Stale Form 51]3(R15I S14)
Prescribed by the Depa-onent of local Goverment Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal idenfitcaton numbers are confidential under IC 6-1.1-12-37.
- - /•"-• - . . _• : - CERTIFICATION STATEMENT :' - •.. - ."7-77.1"---;.i. iv:V.'s
I(We) /� _ ' - tn - certify that I(we)octal as ,+
NNN +...:I 1
place of residence or am ire)buying the following described real property under contract for which a Homesten• P •• 5 `•-
Deduction is hereby dal S on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contracL NOV 4: 2016
❑ 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 person- �--denceir
❑ Am(are)the shareholder, partner, or member cf the entity that owns the property. r
WerfIi,
-.
%
If
bvaing on comet.Fee Simple owner's name
Reorders afire Mere conuam s recorded • Record number 1 Page
ft-to _.._.t:, Y-Tr '3.;- ..e?t .l.'s `PROPFJiTY.DESCRIelfoi y3'- ?-` �'
_ County Township Taxing/deb-d/(city,,tong lams) n
Parcel nrrnbar Legal description I. (b Is the property in ctesbon
Pr- LOC tat /io ❑Real properly ❑Amway asessed mobile home(/C 61.1-7)
If any parin of the resierial ar^odme or the land not es eL-g ax(I)acre that imneiaty stemmas that structure is used to produce income,describe the use and portion
of the property!Lih:ed to produce ixo e.
A6 - ta _ t/8 - poi - 000 . 7 9y_ oi8
- PROPERTY OWNED ELSEWHERE BY,CLAIMANT--- - - -
•
Rat_.Carty.and Township Is claimant vacating a homestead?
. . ❑ Yes ❑ No
Sgne-re d claimant A
I hereby certify the above statements are true,certect,and complete 7 _ / / n _� J
KAddress of(Wad(number and street.dry state end ZIPade) _ l�7 Mdress��of vacated homegea—d,If arry(number anand/snel. Y.gate endyLP code)
ASSESSOR USE ONLY I .ASSESSED VALUE I. -,HOMESTEAD VALUE • ' .NON-RESIDENTIAL '
VALUE
Land not exceeding one(1)acre immediately '" ±d"
surrounding residential improvements I11)
Other land 1(2) - .. tutu _-.__.,
Total land(line 1 plus line 2) I(3) - - _ - _ -— -
Residential Improvements or Dwelling (4) - •- -_--- 2—r+
Annually Assessed Mobilel T• - -- ;-_
Manufactured Home Garage (5) i .T• j
Other improvements I(6) _ -`k
Total improvements(line 4 through line 6) I(7)
0
Total value (line a plus line 7) I(d)
I hereby certify the above is true,correct, I Signature ofAasessa Date signet(month.day,year)
and complete.
Vaeying ac on-Signature of Aad:or Data signed(month,day year)
n I,y—'- -$O,'_' Y,y "_c 1".;=,STANDARD DEDUCTIONALLWANCE "'- cy"'_s'r
20 pay 20 Lpcsnr of 60%of the assessed value of the homestead or$45,000
Nofwrhslanding any other provision,the sum of the deductions provided in IC 61.1-1210 a 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-halt(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Atdtor Date signed(nveh,day,year)•
J r m/ '
DISTRIBUTION: Pdxc Fi