Homestead_Mobley CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
x ��:;.. STANDARD/SUPPLEMENTAL DEDUCTION FORM
SxeFarm 5473 Q(i7/1-f6) HOlD rI —
•y Rao em by t DR �f or lncW Govamav rFmw 1`
INSTRUCTIONS See'event side for fling instructions.
NOTE Telephone.Sodal Seaairx dimes ecense,state identiSarbon and federalIdentricafim numbers are con5deidml under IC 61.1-12-37.
CERTIFICATION STATEMENT - - 1�
I(We) /AP• � �; ��tif/ do certify that I(we)occupied as my(our)•• ..'pal 21
place of residence or am(-'-)• I. '- .,r,.I •described real properly under contract icr which a Homestead P ••- Tax Standard /7
Deduct on is hereby damned co •,.date this apphcavon is signed, (date of signaler 1: ( 'e):
❑ Am(are)entitled to occupy as❑a tenant-stockholder a cooperative housing corporation. G/BSON COUNTY to Am(are)buying under recorded contract.
❑ Am(are)beneficial interest partner, r me a rightf the espy under the terms of a qualified personal residence trust1 a/o-
1dY property. i OR
. ,
Township Y�w/ .
Paced renter -
i7 �, 6 J02—.3_/a t any d Oe rendered axe a ee trM el exat •V ore(fl are a��dote c d m produce income `fy'. .•
_ .. __.�_ _Ea _e_•1'T.i x111=..i-;a?R02ERTY.OWNEDELSENMERERYC[FIA7ANT azn, =�,yp��1- '"''y
•Carey am Ta^dtp Is claimant vacating a homestead?
0 Yes 0 No
I hereby certify the above statements are true,cored,and complete. s¢aare i -4 -”
Address Cl coned(nmbrend meet,ay,stem,and Wade)
0 ) S 0 7_ 4.-3 G S e u _ Ar_... �..
t ..,.ASSESSOR USE ONLY t � ASSESSED VALUE _ „,:t._1\ HOMESTEAD VALUE' of N9N7-9uENTIAL
Land not exceeding one(1)are brm edehly 'S*4+ra l'T -
surrounding residential improvements (1) -." .:'ii
Other land --• i --
Total land(line t plus Line 2) (3)
Residential bnprovaments or (<) x `s. .a u '-
;
annually assessed mobile f . F -3 „ -3.
.maruFddtumd home Gage (5) ,?-t-S�n. . _:.
P T
Other improvemenb b) _ x_ ,K;;-:&.x,.. ,: k,`r
Total improvements(line 4 through line d) CO
Total value(lino 3 phs fins 7) (a)
I hereby certify the above is true,correct Signature dASSassa Dave signed(moral{dry,yea)
and complete.
Veyfig amen-Square CAUSbr D rn algae(rrve-ti,MY.Yea)
eti-s i., -_ .-r..e'-L-- s ..--,STANDARD DEDUCTION ALLOWANCE- -`"
20_pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notethstanomg any other provision,the sum of the deduction paraded in IC 61.1-12 to e mote home $
that if not assessed as real property orb a nvmlfadumd hone that is not assessed as real proper ymay
not exceed one-hal(12)of the assessed rake tithe robde home or manufactured hone.
• Sgta,fe dAztr Date aged(morek tact)e)
DISTRIBUTION:Crigin l-County Aorta FiSanped Copy-Tarawa
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