Homestead_Jackson CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
' } STANDARD/SUPPLEMENTAL DEDUCTION FORM
M i Slum Form 5sn(Rn/t-t6) HCIO
"/ Prasnmed by the Department et loud Government Fauna
INSTRUCTIONS:See reverse side ler Srog instructions.
NOTE:Telephone,Social Seaeit$diver's license,stets idvtr,3carmn and federal iderCACamn numbers are co-Martel under IC 6-1.1-12-37.
I(We) certify that I(we)occupied as my(ow)principal
place of residence or am(are)buying the desoibed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this ' is signed, (data of signature). I(We):
❑ Dan ❑ 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 tout
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
_ _ .
Carp Toots* Tang dudiC(cr%assn foch 4 a • r
.'
Pact natter IelgJessrrypdm bee lropatYb• a • '% ,.
❑Reellta�orty glace income.,__�+ _.L -. -(K 6r.1-7)
It any portal C Na residential awes a en lad not eora'g One(1)ace Thal insedately sarovrda that�GILA4y�b pmdse income,delete go use and portion
of the progetyy totted b produce intone
r�,,�/ /pvj�)
a6-1y- IV- 401- to !. 34a- 7
- •-c-Tr3.e PROPERTY-OVMED ELSEwHE.REBY_CLAAIAN .r2k- a'r1- 2Y-v:;.
Sate,Carey,aid Twsotep Is claimant vacating a homestead?
❑ Yes ❑ No
Scream• claimant
I hereby certify the above statements are true,cornett,and complete. t' Ay
Pddres a ca6tl(raalaaet sheet city.lfCe,end ZIPmCS) ' -at sated ttmnesmad,if (numbeasd'beet any.=a.endZPwcb)
-- __ t
-,,, ASSESSOR USE ONLY 1 • CI SSESSED VALUEtf..,,l ' HOMESTEAD VALUE:,_I t O!!RESIIUEI TIAL -
Land not exceeding one(1)acre immediately - - r A
surnwnrlmg residential bnprovements (1) M `� 1- 4«Tx. F ::,>
Other land ; &.`Y.1u- ,5
Total land(line 1 plus the 2) (3)
1 e
Residential dal essed mobile or Deviling (4) ,} .:�sss:'.>=
ennufac .red home mobile qq
manufactured home Gauge (5) r .r _ ii-4':: ,e:
Other improvement. (6) V k ,,.F,: ,±4%
Total improvements(lined through line d) (7)
Total value (line 3 pea line 7) (B)
I hereby certify the above is true,correct, Sim of Anew pare sleek(naexlr,lux Tea)
and complete.
Veityag action-Sonatre a'Aat. Date egad breath day,Tea)
-:..,r i.L r .n[-STANDARD DEDUCTION ALLOWANCE-. a
20 pay 20_ Lesser of 6D%of the assessed value of the homestead or$15,000.
Natedh5arffirg any other provision,the sum of the deductions voided In IC 6-1.1-12 b a mobile home $ •
that is not assessed as reel properly or to a nixedNtrred home that Is not assessed as real property may
not exceed uthor�va2xswu rwbrle home or manufactured home.
S ee otAUdtrr • Dab signed Moira,dcT:Tead
D6TF®UTIDN:Original-Carty Ate,191e-awed Copy-Te aya
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