Homestead_Allen (5) r.
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD1 SUPPLEMENTAL DEDUCTION Hcm
-�" State Poem by 73(Depart ta)
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS:See reverse side for filing instructions _
NOTE:Telephone,Social Security,driver's license,state identification and federal;dentiication numbers are confidential and i 1 6-; -f 37. • ;._,
.. -.. 4, ... -• CERTIFICAHON STATEMENT.1"—,517."")-... _TT -C ;-±1 !"6-,=l»'
I(We) 1 r ei
__14 . - I(we)oJpii t )S a I
place of residence or am(are)buying the following described real property under contract for which a Homestea n}TO rd
Deduction is hereby claimed on the date this application is signed, - (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract. , 4 ei
❑ 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 c{adi `4/16G®tAAH€ttdf(t#D(T II R
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
- ,
If buying on contact.Fee Simple owwa name
RSC9rd&S oSca where carted O recorded Record number I Page
o �at"tr S rva -VPROPFRTY.DESCRIPTIO4 r
Cavity T tiP Taxing• '� . l
i -n A
Parcel number Legal d/ess:iP�on� r--/,fir (/ I Is the property in queaben
t r,.oil .ILM:7d einYr+ • Ili ❑Rea]property ❑Amway assessed male home(Ic 6-1.1-7)
If any paean of the residential=GYM or the Ian not esmedng one(1)acre that"e.:-xda'aly sun abes that e-uzae is used to produce income,des_tbe the use and portion
of the property Lazed to produce income.
016 -/a, . ( 8 . la ,3 _ 001. I ? x - 001- 8
PROPERTYOWNED ELSEWHERE BY CLAIMANT
Sta Coacy,and TornuNp Is claimant vacating a homestead?
. . El Yes ❑ No
I hereby certify the above statements are true,correct,and complete
Address of contact(number ad erne]dry,Sete,and LP code) Address oft .ed homestea,if any(number and sheet,dry,state,and ZIP Code)
�D t . 1. / I "_. tit t1/ o
ASSESSOR USE ONLY t f ASSESSED VALUE.
HOMESTEAD VALUE _ NON-RESIDENTIAL -:
Land not exceeding one(1)acre Immediately ((1) __ 7.---`7---,
surrounding residential Improvements -
Other land (2) ---
Total land(line 1 plus line 2) (3) -- - - - - _ _ .- _ __ _
q.•7•74:17. -_:_7-
Residential Improvements or Dwelling (4) ?�j�`
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) 1(8)
I hereby certify the above Is true,correct, Signature of Assesses pate signed(month day,year)
and complete.
Verifying action-Sigrabrre of kola Date signed(month,day,year)
I
?, -.:.-r y f "r e: - STANDARD DEDUCTONALLOWANC -.IL_ ar`t i
• 4
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or 545,000
Notithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ MAY 1 7 2017
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-hail(f2)of the assessed value of the mobile home or manufactured home.
Signature..Audtor , `Date sjpad OVA r..re
DISTRIBUTION:Original-Canty AUdfr,Fie-Stamped Copy-Taxpayer / Ult3bUN I,ULIN(Y /AUDITOR