Homestead_Rexing (11) VC-cri,.;; CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
((--b ;,7 STANDARD/SUPPLEMENTAL DEDUCTION I�
eiSaa Fem5473(Rt7/fah) L''!
Pmsflod by the Oepatnt at Lael Ovvanomt Franca r,.1ti -el—vi tw'
INSTRUCTIONS:See reverse side fording i,stvcfons.
NOTE Telephone,Soda/Seaaltx drivers - ,.. slate aknfScakml and federal itr t mangers are coal* f!ad,•...(1061.1-tail
CERTIFICATION STATEMENT .
I(Yea) .aV.i lid►t �� certify that I(we)occupied as my our) :t •Pal
place of residents or am(are),:.h -.the fallowing descnbed . ..• under contract for which a ..1.-•s Vine=t/ ax Standard•
Deduction is hereby claimed. -date this application is sl t /.. - . . .`Y ((vvww)>
G)na1i • CO!J ;TY . UDITOR
❑ Own. ❑ Am(are)buying under recorded contract
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation_
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal residence tent
❑ Am(am) the shareholder, partner,or member of the entity that owns the property.
. -
_ • .
•� :�� all SL . r1
--�ruffia4 �I1 -a1��.j� lapel Oesrriptc ��Q nJ Is the prrycay in Westin[ -• to-I 1 !-3W �. g4-8 Rr-0enr ❑Annual/assessed mot.%lmm(a:6-1.1-n
11 any Paten d the residential saucers a ere laid not emedng me(1)am sdraants stoma is used m proare income,dno®e Use us and paten
of the property voted to proem Income
s7•_7 -�-.,,:+' i c.. '. . .P,ROP,ER7Y;OVlNEOELSEWHERE BY,CLAIh7ANiS'W - <77x
Sam Carty,and Tovnattp Is daimant vacating a homestead?
❑ Yes ❑ No
Swam of churn
I hereby certify the above statements are tune,correct and complete. t
.el
Mamas aCVaad(meter art sheet,day.fie.and LPCnm) Aaes d,v411“ --. • eengesu terwJrteet(a/:set,W a>coda)
. SO G E SSo ou-+`-
-'-s .ASSESSOR USE ONLY ! ASSESSED VALUE4 I SHOMESTEAD VALUE.\:�� _ _ NONRESIDENTIAL -
- _'-VALUE t
Land not exceeding one(1)acts immediately
ai `id t {
sunouseg redemml unpoaemenb (1) t ; „V Y . -
,
Other land
Total land(line I plus line 2) (3)
To.e r • ,
Resudadiai Improvements or Owebbmp (4) >_,.-s _ r _ :.
annually assessed mobile I k ,7 .
manufactured home Osage (5) ..._3,31; tTq.r...:.. .._= 7.
Other improvements (6) _,_...r�Z'.y, .^.�¢ •.
Total improvements(line 0 through line h) (T)
Tout value (line 3 plus line 7) (6)
I hereby certify the above Is true,correct,
Signature dASSesam Dare simr0l(emnsq day.lea)
and complete.
warm mica-Signature cfUdvr Data s (r_xrq day: gal
20_pay 20 Lesser of W%of the assessed value of the homestead or$45.000.
any otherprovigms,the sum of the dedxgbns prodder/in IC 6-1.1-12 to a mobile home $ •
that is I assessed as real property or to a manufactured home that is not assessed as real property may
not ex d #ne-had(1R)adNe value of the Slide home ormandachred home.
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