HomeMy WebLinkAboutHomestead_Coffer Pte : PROPERTY TAX
CLAIM FOR HOMESTEAD PROPERT FORM
YEAR
t(E)�]r-,��.:,,: STANDARD/SUPPLEMENTAL DEDUCTION
1. 4�iel SOOFam5a73(R17/1-16) HOW
C4�J,i'7 Presoted by de Department d tart Go.mgre a Fauna
INSTRUCTIONS:See/cyan side Wrb6g 6rstrrxSau j
NOTE Telephone,Soda(Segan%MYe/s roense,stale idenfisration and federal JMnticffion numbers are mlidentad under IC 6-1.1-12-97.
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CERTIFICATION STATEMENT i
I(We) aIfi_ ., - `i 7�r 4 W h ii _I, certify that I(we)occupied as my(our)pine, -
place of residence or am -)buying the foOowirg described real ff.:-. under contract for which a Homestead Property Tax$Bullard
union is hereby claimed on the date this application is signed, (titre of signature). I(We)):C Tl. 5�
Own. ❑ Am(are)buying under recorded contract
Am(are)entitled to ocwpy as a tenant-stockholder of a cooperative housing corporation-
Gies. • Zo,,.,
❑ Have a beneficial interest in the trust or the right to occupy the property trader the terms of a qualified personal — ' r
ID Am(are)the shareholder,partner,or member of the entity that owns the property. •// e•
•
/ _,,/
1Legaall deSC a / / //n Is the brryestlwe
y/� 1 c -oi lY arPrVaq ❑Annually assessed ob.Mrne(IC 6-1.1-7)
It�at residential swrareaIi lad nd ae(1)e.t.a/Also ireemxey///tell....--- Mat mixture u uaedb Waere MOVna,describe de use and portion
d utbed to produce krone.
aG -/a-a 2- aroa-azo. /€cs--oda'
°' 4:iraA tr~9:I PRORERTY OWNED ELSEYIHERE BYrCLAILIANTO''+: ,...' r . . .v T t.--
%Os C°n1y,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
I hereby codify the above statements are true,coned•and complete.
l mesad Se'i, city.&we,and ZIP Aides of ranted • ----,dart/�saes(c%1
3b,end ZlPw6)
•
'ASSESSOR USE ONLY ;.i•- ,ASSESSED VALUE , ' HOMESTEAD VALUE. -I °N0t1RESIIDENTIAL
era not exceeding one(1)e Immediately^ m s,w :1'4r
surrounding residential improvements (f) ..>:•-: ?iL _ _r`
Other land (2) �. :{.` '$ 4
r i E 5'r,.. ..-.-
Total(and time 1 plus tine 2) (3)
Residential hnprovemems or Dwelling (4) - I-
annually assessed mobile I r '"
manufactured home Garage .{' rr s
Other improvements (6) �i:5_.afla.'I *p,- ra
Total Improvements(line 4 through line 6) (7)
Total value(fine 3 pits/Me 7) (a)
I hereby certify the above is true,correct, S olMsessa Dam signed(noreh day,yea)
and complete.
Verifying anon-Signature oAudbr Dab sigma tame%day.Wa)
20 pay 20_ Lesser of 60%of the assessed vise of the homestead a$45,000.
NoMrMslant: g any other provision,the son of the deductions provided in IC 6-1.1-12 to a mobile Mme S
that R not assessed as real popery or In a mantlacaned home that is not assessed as real property may
in exceed one-hat(112)of the assessed vakre of the nobdq Mrre ormanufactured home.
Sgnars dAUdbr Date signed(nn'a(1ay,yeew)
DISTRIBUTION:Cdgal-CaagAsSa,RaSTamwed Copy-Taxpayer
Pege 1 at 2