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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 Page I of 2