Homestead_Clevenger (2) «• CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
ip�t�;j% STANDARD/SUPPLEMENTAL DEDUCTION FORM
`r,ivp Stab Faro 5473 Ma/t-16) HCIO
PresabeG by to Deyarbet of Local Gaeaoaa Finance
INSTRUCTIONS See reverse side by filing 6rsbuc6ons.
NOTE Telephone.Social Security divers Scertm.stale Manta:Wn and federal A*nrfta5on numbers are cm5dental under IC 6-1.f-12-32 yoT®a
I(W) w certify that I(we) i .1/
plane of residence or am(are)buying the fofoirg real property under contract for which a Homestead Property Tax
Deduction is hereby damned on the date this application is signed, (date of slgnaturgio,(V J:
❑ 0 ❑ Am are buying under recorded contract IN V j 4 2017
❑ 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/r)1sitlmice torsi r d�
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
• ' : .
--. — -
Canh Torn ht' Tsag/Istria(rosy;tact lco_s/rNp) //
Pares master Legall desa�pann b the tea tic: //
T)�L�/VI [Ni a alPaly ❑VVV assessed mate tone(IC 61.1-7)
1l ere Paten d the r atii aucese a es land na goe(1)eye eat' anndsthat structure is mete Rmam Income,describe the use and prom
dare property dgad b;reduce inane.
aetr — / 7 - /al. - Aloo — 705, a- aP -0 -1- /
oiMY:Sa T5. :`.b 7 T.iy PROPERTY,OWNED EC-SEPHEREBY CLAIMANT'�r 4'.';_ :• E:�k 074-441.
s'ars.Gouty,and Taina'P Is claimant vacating a homestead?
❑ Yea ❑ No
d
I hereby certify the above statement are hue,coned.and complete.
7
Address d artad(nraatereIrtntt cdy,sas.endEPco*) of vacated hsreslod,a any(maw daee(ay,state,edZlPade)
C 6 _ o r_.. s • P_ . a hag k e,e
- ASSESSOR USE OMLY -, j`:.. ,I ASSESSED VALUE_ ;4 HOMESTEAD VALUE _ 1 NO`1 yALIUENiIAL. - - l
Land not exceeding one(1)arse Immediately r•,• -cars °--4`-
srmroudingressidentia l improvements (1) ., �v" - - -K:a
Other land R) i s .ac
_ _a°O11C:ea_..- ^•. ,.
Total land(line I plus line 2) (3)
Residentbl improvements or Dwelling (4) a.� . ,;.F
annually assessed mobile I
manufactured home Garage (5) ��
Other Improvements (6) •sifsT?•yti j..:,E�r.:, F.;'
Total Improvements(lute 0 trough foe 6) (7)
Total value(line 3 pia line 7) (6)
I hereby certify the above is true,correct, Siga>De cASSessa Dab signed(.max dux year)
and complete.
Verifying dam-Signasse 44 Auden( Date signed(m ak thy,Yeah
•.Gtr b .--- r:F: ,<_. '. STANDARD DEDUCTION ALLOWANCE. 3.4 si-'r _..
20_pay 20_ Lesser of 60%d the assessed vane of to homestead or$45,000. .
-
NohNtsranigrg anyother pmvism,the sum of the deductions provided In IC 6-t 1-12 to a mobile home f
Mans not assessed as real properly or to a manufactured home that is not assessed as real pmperfy may
not exceed one-hall(1/2)of the assessed value of the mobile home or manufactured home.
Slgsasae,dI Avatar Data dpmd(mate day Yea)
/�`' • /'AA. ,> o--' / —
Day1fRIDUTION:0da'i e/-CattyAud3a,FbStamed Copy-Taxpayer
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