HomeMy WebLinkAboutHomestead_Klusmeier : CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
eil.. t STANDARD!SUPPLEMENTAL DEDUCTION FORM
Sete Faro 5473(R1711-16) HC10
{.�y Prescribed by the DelreMmt of Local Government Femioa
INSTRUCTIONS:See reverse side for Ong bebucbont
NOTE Telephone,Social Secwdx drivers license,to idenercadon and federal id a:lik n numbers are confidential under IC 6.1.1-12-37.
,I • CERTIFICATION STAT t.,I NT
•
I(Wk) ATE II .e�y i�n e .e • i liNit_ . Al:^I.C.- !,,r.•e.pied as my(our)principal
place., res ence or am L -)�,. a the fo0owing deathbed property under contract for which a Homestead Property Tax Standard
Ded •" is hereby clad I -date this application is signed, (date o1 signature). 1(We):
Own. ❑ Am(are)allying 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 trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
- - .
Canty Toesstlp Taxing district(ray;fawn/1oo.7stt)
Parse ember toga desap5vs I Is Me acj4 quesaorc
I 4^f•Rfeatfacpary ❑Anna 'assessed noble hoe(IC 6-1.1-])
If any pore=of he residential staters a he laid not a rceedag one(1)we that immediately samxds that sttu=ae is used m produce income,describe rte use ant portico
d the Property ut&ed to random inane-.
ag• -( i - II -aoo- opt. 'n& - oal
, _ . .. : PROPERTY,OVJNED ELS_IIHERE BY.CLAIh1AM1'T ' `'-u ,.;= - -
State,Canty.and Township Is claimant vacating a homestead?
9997fff ❑ Yes ❑ No
I Hereby certify the above statements are true,correct ant complete. ct/� :'1[ r 1 (� \. . ,I, .
Address d mead(number and street ay,sty e,end Zusco*) '..._"_�\ova=te h dd..if ay(numb edd&net oily,s5c. 1md7'(PiF/_"c) lAt/v
... e. y .=ASSESSOR USE ONLY' - ! a ASSESSED VALUE I1;9 HOMESTEAD VALUE S- ...7 ,RESIDENTIAL 7:-:',.--r.:)
Lend not exceeding one(I)ace Immediately �. ,?
surrounding residential improvements (1) f ED
,
Other land R) 3
Total land(lure l Plus line 2) (3) `�T I�
Residential improvements or Dwelling (4) gg y { + c. _ :
annually manuuactuurieed home mobile Garage (sj JUL 2 Za6�._ -- r
Other improvements (6) y$�. +-u r
Tote)improvements(line 4 through tine 6) (7) / I/ .- elrllll!►i
Total value(Brie 3Phs linen �> GIBcotii COUNTY AUDITOR
I hereby certify the above is true,correct, Siae"tas of Assessor ti'''e sued(nmreh day,yew
and complete.
Verify in action.Signa'+aa ofAettr Data siged braaJa dal:lean)
•
' ' '" - ''STAIJDq RD DEDUClO1J ALLOt'JAWCE"� - .o«..--e -'.'— "'
20 pay 20 Lesser of 6056 of the assessed value of the homestead or$45,000.
Notwithstanding any other pmvision,the sum of the deductions podded in IC 6-1.1-12 to a mobile home S •
balk not assessed as real properly or to a manufactured home Mat is not assessed as seal property may
not ex ore-ha!(12)0f tae access value of the mobile home or manufactured home.
ore ��Pic) �7( �yyeI
7-n1d-17
DlSTRI&rt1ON:Original-CmayAulla,,Fie-`.tamped Copy-Tepayer
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