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Homestead_Stocker (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
Cr-
{E m,?..1 e. STANDARD/SUPPLEMENTAL DEDUCTION FORM
`!" State Form 5an(RI7/1-16) HCIO
^�� Prescribed by the Deparbea d local Govanrem Finance
INSTRUCTIONS:See reverse side for film iuburbwu. I
NOTE Telephone,Social Security drivers kerns slate ederff3rabm and federa110vIDLCa6m numbers are pml5dnpel ,i--C+f .1 12-37. , _,
CERTIFICATION STATEMENT
I(we) /r-orlairftnenwA i�salt? I. certify that I(we)oavPed as my(our)phi t• .
place of residence or am(are)buying the following described real property under contract far which a Homes? b'n{°pty T rd
Deduction is hereby daimed a l the date this appfcation is signed, (date~ate,ofssgnatut m). I(�
❑ Own. ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to oco ipy as a tenant-stodcholder of a cooperative housing corporation. ,�j�,¢_---
❑ Have a beneficial interest In the trust or the right to occupy the property under the terms o61$s�IN7Y"fe a trust
❑ Am(are)the shareholder,partner,or member of the entity that owns the property. AUDITOR
?
- _
Casty Tawsalp Taxing Ostia gay,loons mew)
Past nub Laps deaciplm Its me property a Question .
❑Red PoPerty ❑Amway assessed cotta hone(C 6-1.1-7)
n ere portico a ma reskIert encase v the tare t savable are(1)sea Mat inne3Seysamtn6a that straaee Is used b proEse ieune,describe ae use and portion
a the rncoaty cased to produce income.
a (0 -a3-010 - 103 - • odt1)39 -Ape
• .::2F .'ci PROPERTY:OWNED ELEWHEREBYCLAih1ANT¢ r" -- ~7s.t,7
Sib,Coxay,,at Township Is daimant vacating a homestead?
sy+r,�e yet /❑ Yeses❑ No
1 hereby coitify ice abase staterttatls are true.axmct,and complete. X a a1/Address a mrtact flu, ad skeet city.Are,aid Z�coY) Address a vacated If any(minter and drew&.obi sale.end ZPcode)
!/ v'r .-, 4.tjlr L h/a,S,,icJ#,f YY(i if
-ASSESSOR USE ONLY = _ I 'ASSESSED VALUE U ,..HOMESTEAD VALUE. u NON-RESIDENTIAL ;. .
. ^I ... � _VALUE ..
Lend not exceeding one(1)ems Immediately $-.
surrounding residential improvements 0) • .r_ix1' 4
Xt i
Other land (2) a s�';1'-_: _
Total land(fine 1 plus line 2) (3)
_
Residential a assessed mobile w OtveOrry (4) ▪ `=irl3.
�.i
namely assessed mobile I ♦ _
manufactured home Garage (5) - k _..
Other improvements (6) ._... -t; -.+<_.rY.233;}-. _
Total improvements(line 4 through line 6) (7)
Total value (line 3 phs line 7) (6)
I hereby certify the above is true,correct, Sipv�ve of Assessor Dal sped(er tt day,year)
and complete.
virility action-Sipukse° acabr Data Signed(Haab,dee lea)
"` -� "C- '°�' ' -STAIIDARD DEDUCTION ALLOWANCE. " -
20_pay 20 Lesser of 80%of the assessed vaue of the homestead or$45,000.
NoMithstandi g any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not d as real properly or to a manufactured home that is not assessed as real property may
rot exceed ay(1/t)aNe assessed of�wmaudacirred home. '//�/
Signature at ` J` )(26%.) Dos signed(me%day,lea) f
to - a-I
:Origami-CauayAzt.Re-Snood Copy-Tax aler
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