Homestead_Siekman (2) ,4 ,; CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR
CV STANDARD I SUPPLEMENTAL DEDUCTION
FORM
Sate Fan ( i5/5-1er) C
Pnpaibed by the Department
of Local Government Finance
INSTRUCTIONS:See reverse side for filing insfmctbns.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC• t W
` - "`"CE"`-CERTIFICATION STATEMENT ° -' - 71 ail I 1 I).. 1 Lit
I Me) _ /I/ • • .._ —v!/' di_.i• certify that I(we)ocapl • _ m . • .:-
-
place of residence or am(are)buying the lowing described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date• 's application is signed, _ (date ofsignaturatpRNES 2 2017
Hoorn. ❑ Am(are)buying under recorded contract A
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. A
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified person- 1-.9; q ; ;i( .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. GIB$O • . •
C buying a,contract Fee Sinpte owners rame
Remrises o5ce where woad is recoded • Record number Page
�s._�.�!Yes?�r;`.+,PROPERT';DESCRIP.TION;_¢.±��� x :itti'
'Cary Township Taxing Sod( f own,fffvemsnt))
Parcel Legal desai$tt Is the npropery in m�ae
aPe , weal property ❑Armuaiy assessed noble tome(IC ef,1-7)
d a:y pw on of the residential sttntre a the land not ezmedxg one(1)ace that im-edaely=curds that=wore a used to produce inmate,describe the use end podded
of the propeM uufaed to produce income.
alc--73-aF- 300 w /- 759004
- PROPERTY.OWNED ELSEWHERE BY CLAIMANT' ' . ' •- '
•
5�i corny,and Township Is claimant vacating a homestead?
'S Yes ❑ No
'Or f' STa/:ure of tlamar4
',,-:{. /hereby certify the above statements are true,correct,and complete. (.a✓)'nfjnoL sA:ejers r'-V"I
Address of arntd(number end street ctt Sate,end ZIP code) Address of vacated homer ad,d any(number and&feet,rdy,elee end ZIP code)
2`3380 S. 75o E' Fr'anci5(o,TIV `/7b
•
ASSESSOR USE ONLY ' I • ASSESSED VALUE- 'I HOMESTEAD VALUE •I " 'NON-RESIDENTIAL".+ u
Land not exceeding one(1)acre immediately
surrounding I
surrounding residential Improvements (I)
Other land I(2)
Total land(line 1 plus line 2) (3) - _ I
•
Residential improvements or Dwelling (4) i� `1'"f�' `"" �".t_p
Annually Assessed Mobilel
Manufactured Home Garage •
Other Improvements (6) I.g':j_„-•S-:.` .: . .__ .._
Total improvements(line 4 through line 6) I(7)
Total value (line 3 plus line 7) I(e) I
I hereby certify the above Is true,correct, I Signature of Asses= Data signed(month.day,year)
and complete.
Verifying adion-Signature ofAUd:ar Data signed Unman,day year)
da_f,'Wt"la =3'r a ?STANDAARD DEDUCTION'ALLOWANCE M ? 7rgrey-3'
20 pay 20 1 eccer of 60%of the assessed value of the homestead or S45,000
. Noheithsianding any oherprovision.the sum of the deductions provided in IC 6-1.1-12 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-halt(la)of the assessed value of the mobile home or manufactured home.
Signahm of Audtor Data signed(math day,year)
!!/L2- .� r - e°?'S'/7
DISTRIBUTION:Otigilal-DourlyAud3r,9e-Stamped Copy•Taxpayer