Homestead_Lewis (16) sr . CLAIM FOR HOMESTEAD PROPERTY TAX
.r..i+, FORM
YEAR
',. ....,p STANDARD/SUPPLEMENTAL DEDUCTION
)._7 Stan Fam5473(R17/1-16) HGIO
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Prescribed tyteOeyamiaa dlarl Donnas;France 2c�/�
INSTRUCTIONS:See tavern side harSll g iuNxbora �.
NOTE Telephone,Soda!Seaey(ors Eceae,stale iden6SWbon end federal Werd&Ca6pn numbers are mrtdenbal under IC 6-1.1-12-37.
CERTIFICATION STATEMENT -
l(We) W w'..r A / i a 1 n/W i. a I/ I certify
place of - +: 'v;'. (.r buying the following desmbed real property under contract for which a Homestead P .- j:. fri_..-Li
;•-• ••• 'is hereby claimed m the date this application is signed, (date of sign-,re). I(We): -
1�q.n-�- ❑ Am(are)buying under recorded contract DEC 13 2)11
L i Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to oco py the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. •
• -
Daary Towdtlp ....dsairs�'
p.
G�� {p
Pall minter Leal desatPaai Is ere Propmy m question 5 t 1
_the
p ceahy ❑Air trey assessed oetl,tome(IC 61.1-n
perry paten dme resaatAal s6vdueatat tat in oneedsg ae(1)acre Nstimre&ayaammdo that srnsaxas used to prcduce ircome,sesame tsaw and Achim
of the popery utted b annum vm>a
2 / - I5' -Z4 - Z0 / 70l3FO 6a o
_.ati,„55cv + .P,ROPERTY,OWNED ELSEWHERE BY,CCAIMANT ,;r .i 1, . e_, _ a-°
State,Carry,ad Township - • -. n t/76 ye is claimant vacating a homestead?
307 5 . l� , GiOr ST � . Brg/Vr A Sri ❑ Yes ❑ No
Sure of dannent
I hereby certify the above statements are true,correct and complete. (0 p�/
/v 4 (/74--C- 1
Adders a contact(numbered street dry,ebb,ad2/Pseb) Attires;uf mated hare>mat,V any(numterand straita%,state,6a]ZPmc6)
a
ASSESSOR USE ONLY ASSESSEDVALUE �. HOMESTEAD VALUE. .;l NON-WLIUENTIAL:'
Land not exceeding one.(I)acre knmediately
surrwdmg residential improvements (1) rw *>S+r t4 t ?s
Other lad : '
Total land(line 1 plus line 2) (3)
Residential verve or Dwelling (4) L M.:12r-lItgZirtatie
annually essed mobile I Y ; - •C4. t
-
manufactured h ome Garage w
vp v .-i
Other Improvements (6) _,,g. L.�'''__. -._.
Total improvements(line 0 through line 6) (7) _ -
Tot value(lam 3 phi fora 7) (0)
I hereby certify the above is true,correct,
Sim of Assessor Dares Inca dry,yes)
and complete.
Vaitytq ism-Sip,aaae of math( One Wined(mxA day year)
`, .' +••" -' STAISOARD DEDUCTIONALLOWANCE, - >T_^_t--+: _q"--
20_pay 20_ Lesser of 60%of the assessed vhie of the homestead a$15,000.
Nosi/StdnG/g any other provirdon,the sum of the deductions provided in IC 6-1.1-12 tea mobile home S
that is not assessed as real property orb a manufactured home that is not assessed as real prcpedy may
not exceed one-har(1/2)ertee assessed webs of the mobile home or manufactured home.
S gitre Data died(mats day,yea)
L O/JnL � /.r�� ,a -/ 3- /7
DISTRIBUTION:ayua-CaseyAU'd2a He-Ramrod Copy-Tmpsyer
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