Homestead_Heldt (6) ` CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD ARD I SUPPLEMENTAL DEDUCTION
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State Farm 5113(R15 15-14) HC70
Prescribed by the Depannem of nm
local Goveerl Finance FORM
PM
INSTRUCTIONS:See reverse side for filing insbWions -
NOTE:Telephone.Social Security,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
'?.'5-4•fr /s'- ACCEERRTIFIICAATTION STATEMENT-.AT::.i. ^'^f _\--- 'y. _ -.�11.• ^' `
I(We) � ! ( �>i� certify that I(we)omupied as my(oTt licipaci
place of residence or am(are)buying the following described real property under contract for which a Homes=acid Property Tax
Deduction is hereby dawned on the date this application is signed, (date g1•ggnatu -)`2, a): 0/2
Own. ❑ Am(are)buying under recorded contract SON '" _•
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. COLA.P.,,,-,
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal resident
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.�
•4U4y
.-
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tl buy4g an o�caa Fee Simple owners name
Remrdees n5 ce where myna is recorded - Record number Page
s'�S�fF�' ���. tar9r_v-+,'?�,_=.:ireinP,ROPERTV,DESCRIP,iIONnPt2MiL - -'S��;=�"��`�Ty�=�)
Township T- (city,town,for ship)
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All P y /n-) Q_
Parcel number Legal description I Is , in gesdcn
Real pnpero ❑Amualy assessed noble loner(IC 6-1.1-i)
. tl a%(�1(4on of the residential Nniture or the land not exceeding ore(1)an that unmedaaly that stntGne is used to produce income.desmbe the use and portion
of 4.pS�r.,.y utilized to produce income.
dd- � - �-�Oo - Uoo. b�-�� 7
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PROPERTY OWNED ELSEWHERE BY CLAIMANT _ t _
Sate County,and Township Is claimant vamt'ng a homestead? '
❑ Yes ❑ No
Si T51tl imam /4542-3
I hereby certify the above statements are true,correct,and complete. c !>r
i
Address of coma(renter and greet ovy state,and ZIP Ogle) of vacated hsxsead.If any(number and soaet a'Y Sate.eel ZIP coca)
4 ( 5 N R 1 S 4 Crvne-1Jw1
'ASSESSOR USE ONLY I _ASSESSED VALUE: I HOMESTEAD VALUE I' .. NON-RESIDENTIAL .
Land not exceeding one(1)acre Immediately '-T 74
surrounding residential improvements I(1) >- 'L�"_ chi
Other land I(2) -_ - - ..
Total and(line 1 plus line 2) (3) I - _- - -
Residential Improvements or Dwelling (4)
Annually Assessed Mobile l _
Manufactured Home Garage (5) _ -. i-.
Other Improvements I(6)
Total Improvements(line 4 through line 6) IQ)
Total value (line 3 pits line 7) (5)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Ve yi g anon-S5ra5ne ofAgdar Data signed(month,day,year)
rill STANDARDDEDUCTION'ALCOWANCEPj -'�` : ter
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwi',h5anding any other provision,the sum of the deductions provided in IC 6-1A-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may •
not exceed one-hatl(tR)of the assessed value of the mobile home or manufactured home.
'Signstse of AUStor Data sicced(math,day.year)
DISTRIBUTION: Original-County And:tor,FeeSamped Copy-Taxpayer