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Homestead_Mossberger CLAIM FOR HOMESTEAD PROPERTY TAX Foy YEAR
Cr ; STANDARD/SUPPLEMENTAL DEDUCTION _
SYS Fam 5173 OUT i MC) HC-10
Prescribed by Me Depabsad Lath Government Fin
INSTRUCTIONS:See reverse side kw Sing acstrucfaus '
NOTE:Telphere,Social Seoul divers tense,date identitrcaren end federal iclerEisaten numbers are confidential under IC 6-1.1-123 .
1 CERTIFICATION STATEMENT .
1
I(lAe) V�//i •1 • fro -w- s e_- A certify that I(we)occupied as my(a/6�^nPjpal
place of residence a am(are)buying the following desarbed real....../ under contract for which a Homestead Property Tax tat(d 1�601/1
Deduction is hereby calmed on the date this application is signed, (date of signature) (We):
0 Get ❑ ena(am)ckhold r of a type housing�corporation. G/BSON C( t
❑ Am(are) entitled to occupy as a tenant-stockholder of a n�
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal resideh�Po)st.
❑ Am(are)the shareholder,partner,or member of the entity that owns the property- el(/O/jolt
:•w
e buying on mt'al.Fee Saws crane nano
Remtle(s aloe Ware contract Is retrial Record nutter Page
PROPERTY DESCRIPTION-
Carly Tawsbp Tz�y ddtid(oty
Paul amber legal d sa4SVt Is tie prNaly In Haan
7Re5pcpeay ❑Mnn!y assessed noSe tn(IC 6-I.I-?)
If any PDXI d as remade statue or es tale not camera as(I)acre eat inners Iy sure ds that au0ae hs teed In proem iama,dirabe MO hate Ord pats
d to popery Mind to proem axnm. w / -0 5 O . I
a 6.-/7-,3)? a�
-7 rL_ , PRO'PERT •OWNED ELSEWHEREBYCLAIh1ANT " .Tic :L•. --'7
and
Sate,Carty.a Tomehp Is claimant vacating a homestead?
0 Yes 0 No
Swathe of tlmua
I hereby certify the above statements are true,correct,and complete. y
Address of contact(nmeranl street dg:bade.and ZIPcc ) Address of eaaled I--. d.tali(ranter asfinee(dry,stab.and ZiPeds)
V /0611 ' ( 0005 �-triSt ,€ r✓
:15;4 ASSESSOR USE ONLY - . � - ASSESSED VALUE._,_I, HOMESTEAD VALUE._ I - NOif RESIDENTIAL. .h
VALUE'
Land not exceeding one(1)acre Immediately^ •17 gf. f a. .
surrounding residential Improvements (1) }: f.np, Ax�.4:1415,T2.,
K
Other land (2) e .e_254i. ra _._.-...
Total land(line 1 plus fine 2) (3)
Resideraie improvements or Dwelpng (4) L Y E t?'�£_
annually assessed mottle/
-41C -• '� ,` a :--amanuacured home Garage (5)
Other mprovement (6) }- K _�r y,Vi.c:
Total Improvements is(line 4 trough line 6) (7)
Total value (line 3 pile line 7) (a)
I hereby certify the above is true,correct,
Signature at Pasteur Dale agree(nmtq oay.yam)
and complete.
Verifying action-Signature of Aadb Dam sithed(meta day.lea)
•s+>••—Tsr�pr' .s->•."<P —. ."--e' "7: 7 . .-7-""----:.-ter- -tea
... -. �._ .... �STAI:DARD DEDUCTION ALLOYlAWCE'--` , _ _. _ ..
20 pay 20 Lesser of 6(%of the assessed value of the homestead or$45,000.
NoMehstaxfng any other provision,the sum of the deductions provided in IC 6-1.1-12 o a mobile home S
that is not assessed as real property or in a manufactured home that Is not assessed as teal property may
not exceed onehal(U2)al the assessed value of the mobile home or manWaztned home.
Shp�sse
Date sighed(=My day,yam)
L 2111).(, 7-a8-17
DIS1RIBUTlaC Original-Corny Ada.Ha-STanped Copy-Tapela
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