Homestead_Marvell (3) ,� CLAIM FOR HOMESTEAD PROPERTY TAX YEApt
fl(tc..35 STANDARD/SUPPLEMENTAL DEDUCTION
FORM
SJaba Fam5473(117f 146) HCIO
Netaibed tw me 0, .L .at Iota Government Fiona
INSTRUCTIONS See reverse side kw gang i nshmcbos.
NOTE:Telephone,Sodal Seaaihr threes Items,slate der165cabon and federal lrleraref n numbers are conflate"under IC 61.1-12-37.
CERTIFICATION STATEMENT
I(INe) y2.r /la I/ f r _ rIr certify that I(we)occupied--';p,(•. _) .pal :.J
place of residence or am(are)buying the following described real property under contract for which a Homestead P , T-.Stercard
�DDeddu/u��ction is hereby claimed al the date this application is signed, (date of sign.' : . I(We): ^p11
L�Onwn. ❑ Am(are)buying under recorded contract SF.P 2 2 L .
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust a the right to amipy the property under the terms of a qualified personal residenceltrusI ,y
er owns❑ Am(are)the shareholder, partner,or member of the entity that ow the property. -1 Y A (TOR
_ .
Canty Toe ship •Taro a(MY,town/ /,M'
( "-`A et
Parcel ammer lard deSaipas I d lie property in quas¢aa
property ❑Arcady assessed mesa horns(IC 61.1-7)
It any pa ion d the residers damn or Se land not=eerie ore Made Oat kmedmdy samald that Cann is used to praare Income.dear:*Is use and Gabon
due property of f¢ed:pmaa lore.
e
a (o- o'i /L/ 900 000Sa9oi >
.'PROPERTY OWNEDELS_,:HEREBYCLAJA7AI 27):"f -.''; - ''' iy..
Stab:,Can.and Taet, Is claimant vacating a homestead?
❑ Yes ❑ No
9th era d
I hereby certify the above sfatemetrs are true,correct and complete. 7`-'
Address dram(nwdcand abed.airy:date.=1ZIPmdo) Aches d d and meet ray.slab.end ZIP code)
//, ai /8 /7 , /
-ASSESSOR USE ONLY _ 1 d ASSESSED VALUE c`', -HOMESTEAD VALUE_.,hi N- ESIDENTIAL_
Land not exceeding ooe(1)acre Immediately
suffocating residential improvements (1) r e Z?.4
Other land (2) 3c.^"' ..:-71s -r
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) L v _ -a ..,.:,
annually assessed mobile I r £ --
mamdarlured home Gage (5) a 1_ Vi ;
Other improvements (6) _ . ,g._..L n' 21:;
Tonal improvements(line 4 through line 6) (7)
Total value(fine 3 plus line 7) (6)
I hereby certify the above b true,correct. Sim=S dnssassor Dab sired(rrmh,say,yea)
and complete.
Vafi'*n=on-Stye dAUdto Dam limed radii,do,:yes)•-, - 'T . . . -''-4:r 7r''T'.- -STAUDARD OEOUCfro JALLOWANCE:".$-T�"w-a'T"^-77:-='-17-7
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or$45.000.
Afcese stanTvg any otherpmNddon,the son of the deductions provided in IC 6-1.1-12 to a mOb/e home $ •
that Is not assessed as real property or a manuladun.M home that Is not assessed as real properly may
not exceed one-hat(112)of the assessed wake of the mobile home or manufactured home.
wir_d aafter Dam sir ro
signed( an.day,year)
OISTR®UUON:Original-County Alan/Re-amped Copy-Taxpayer
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