Homestead_Maglinger „,,-.V,.... CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
It C STANDARD/SUPPLEMENTAL DEDUCTION FORM
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1 sater RasmveeN see Depamem of loco Goranoe+Pouce
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NOTE 1CTIONS.:See reverse side for Ming instructions.
NOTE Telephone,Soda!Socotra drivers kern,state identi5cabon and federal kkn n numbers are m2edeitedcoder lO 6-1.1-12-37. - ,4(1?”)
� CERTIFICATION STATEMENT '
I(We) �i.� ni •_'i fythatI(we)••• • -c . n (•err =Pal
p of Is hereby claimed am ) the gate this.,.foaming•f. •_• /property under contract far which a Homestead P.:_'rA,er .. •-d eat)
a ski•.-.. (date o)sgnah/ra). T ..�.
Own. ❑ Am(are)buying under recorded contract. Gtie, re?'❑ Am(are)entitled to occupy as a tenant-stocktatder of a cooperative housing corporation. �'
❑ Have a beneklal interest in the trust a the right to occupy the property under the terms of a qualified personal residence trust's%
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. />.'0
R
Tows , fray:town beret)
O. 41,0 theetet
PaRJ ember //�//� ranc 2_)cJV49/z ,L. ✓���m Grgreb ❑�namayassesed mod lame(IC B,.1-n
If any pap=d the tethered stare or the lath not ecceedry one 11)acre that inmate* amt stradure is Used m produce Ito,ease*ae Use and preen
den po+ety wed to pram hcam
al‘-• /7—%?/o% Aso • 033-6a?oz
1= 5 - ter:',_-PROPERTYOWNED ELSEWHERE DYELcIMANTe , 7-77,77,: '?7°,
Sam,carry,at Tomtlry Is dement vacating a homestead?
❑ Yes ❑ No
JRenamme of dairnee
I hereby certify the above statements are true,erred and complete. / '4 •�'�/TJC/ •
Address of mead aeteaarte %My,a am zmmm) Mbew c.sandlvr�srtl.aay(amdaas steapse a�'e••nadie cede)
F �. •CI -1-•lalle °1-IY. rSel�•J:relAtaiealewn\ud Nth °:f' �.
,,Leal not exceeding ore(1)acre immediately (1) �- <'Yr F. =flEtri'=- _
sunwndeg residential improvements
Omer land (2) .^ rz=;?' 'f f
Total land(fine 1 plus rue 2) (3)
Residential improvements or Dwelt* (4) .^LT.:.- t c-_?=..
annually assessed mobile £-
manufactured home Garage (5) , c; t"y-_;_
Other improvements (6) cq>='FEj.� r v.4): ':
Toter Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
I hereby certify the above is true,correct, Sgsatse o saves Gam signed(rmth,day,seat
and complete.
Vafyi g actin-Signaare dNSSor Data sated(mat,day.seat
. .. .._'t.__, 'T• -!-4:- ". `- '"r�T.�`v-t
20 pay 20_ Lesser of 60%of the assessed*tie of the homestead or$45,000. -_ .. .'.,
NoMfthstandrng any other provision,the sum of the deductions provided in IC 6-1.1-1210 a mobile home $
that Is not assessed as real property or to a:manufactured hone Mans not assessed as real property may
not exceed one-hal(1/1)of the assessed value of the mobile home or manufactured home.
Sgsh*of Author Data signed(mark day,Jean
DISTRIBUTION:Ought-Carty/watt,Re-Stamped Copy-Taxpayer
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