Homestead_Stull fill
r'- CLAIM FOR HOMESTEAD PROPERTY TAX I n
r N - STANDARD/SUPPLEMENTAL DEDUCTION FORM
A. State Form
p
bm 73(Dept 5-14)1a) HC70 � 4
Prescribed the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE Telephone,Social Sw•rdy,diner's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37
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• 1. 4,jr.r`" "' - '• -'CERTIFICATIONSTATEMEM'r:', S•--'� ;.," - p"f:l
• I(We) �g1/I'lia//!�a�� iI e AlaAsr certify that I(we)occupie��my( i1'rindpal 9e
place of residence or am(are)buying the following described real property under contract for which a Homestead P ..ti1 ndard 0/5
Deduction is hereby claimed on the date this application is signed, (date of signature if• '
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❑ Own. ❑ Am(are)buying under recorded contrail. 04/4/7 4. s
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 9G
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust 0?
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. 043
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If buying on=tract Fee Simple owner's name
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Recorder's o5®where mrSed is recorded Record number I Page
_ Tr. ..' _`=a ?1 Z,2.f.t PRORERTYDESCRIP.MON� °tri rtz&='
County Township d(0"7(/ta/(xn(/� :.at 410
Parcel number L descriptor ^ , �IIs thee(g._opetty m question: ,
I /`/L(J9_"/'/��'�' p�Real property ❑Annually assessed mobile home(IC 6-1.1-7)
If city pa'JOn of:Y resider..:al sarem a the and not exceed. (1)ace(at a cwdtatery .11/!L/-"ttat sin/Y pre w used to produce Income,des::be the use and portion
• of the property lazed to produce'Ora.e. V fY( �tL
/C go afvxee/a 1)0.eo zCo-a5- i4.-a6G 00=Z . 4,76 -oay
Sate,Canty,and Towm.Sp Is claimant vacatng a homestead?
- ❑ Yes ❑ No
Si re ofd marut
I hereby certify the above statements are true,correct,and complete. / \ t any Address of=act(number and s7eel,dy.state,and ZIP code) va twrcsead.d any number and ioee4 d y,site,and ZIP CWe)
I 6b 611k6 •
ASSESSOR USE ONLY . . I ASSESSED VALUE mI 'HOMESTEAD VALUE,. ;I• 'NON-RESIDENTIAL ..
Land not exceeding one(1)acre Immediately '-
surrounding residential Improvements I(1)
Other land (2)
• Total land(line I plus line 2) (3) _ _ __ _
• Residential Improvements or Dwelling (4) '''w - „�1 s:
' Annually Assessed Mobile I '- "•7`77-5.--' - - -
Manufactured Home Garage (5) �_z I-
Other Improvements (6) -_- �'-- mss' ,
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) I(8)
I hereby certify the above Is true,correct. Signature of Assessor Date signed(month,day,year)
and complete.
Vatfv'g action-Signature of Aud:a Date signed(month,day year)
` g`t _��=:F? g' srq _ STANDARD DEUUCTIUN'ALL'OWANCE '- -c?s �+�d'zap-'z`ir-2'T-"-_"-f tea
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
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Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(172)of the assessed value of the mobile home ormanufadured home.
signattre of hudtar Date signed(onto,day,year)
D15TRIBUr1ON:Original-County Auditor.FieSbmped Copy-Taxpayer