Homestead_Padgett ,. , .. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
rt . STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sao Fam 5473 IR17/1-16) HOW
Presented by me(*partnered Load&sa araa Five
INSTRUCTIONS:See reverse side for filing b ps.
NOTE:Telephone,Soda!Seca.*diver's icense,state deals 5'oo and federal iderransfron numbers are confidential under IC 61.1-12-37.
'CERTIFICATION
STATEMENT •
� r.
I(We) A 7►�u .vn.�1i � C'
i, that I(we)aaaipied as my(our)Principal
place of residence a am(are)buying the following desatbed real property under il r-. fa.which a Homestead Property Tax Standard
Deduction is hereby daimed cn the date this application is signed, (date of signature). I(We):
❑ Own ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporaticn.
❑ Have a beneficial interest in the test or the right to occupy 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.
.
Canty Township at dsWa(ay.tuat township)
j■ Saar m l i\i--V I IDITrlP .
Prof natter La dezo to - - I Is the property h glesCac
❑Reap:Pass ❑A.•snasy assessed mode has (IC 61.1-7)
dam portal el ea raw erdd rinse aced land not eaaeam one(Naas am FnmedaTly stemmas that stone's used to prwmse income,describe et use and paton
a an property tGTmd b p,fla an
a%— I ( -1 3 -.. o II - 0 o • 3C0-cal
sg..�.: _ .'fPROPERTY OWNED.ELSEWHERE;BY•C LAIMAM1TT.R.1= -:-:9?' `". "a ",;.=
Sate,Casey,aid TowaNp Is claimant vacating a homestead?
❑ Yes ❑ No
sarn6rea--'. -.
I hereby ratify the above statements are true,correct and complete.
A 4 °� trr
AadeseaumWrl(nmmbe�aal sets(drysY.e,aal ZIP mds) a-a - my Number and street,city,Yae',mnl ZIP code)
7o y /1-7. C4?fl /2D eldCt e✓1,d 7 b7•
>( . ASSESSOR USE ONLY ' ASSESSED VA UE . .`I HOMESTEAD VALUE. I • 'NO4_RESIDENTIAL'-
- ') � T `VALUE `j •.
Land not exceeding one(1)acre Immediately (f) ur =▪ +7.." = 1y a+xvS
surrounding residential improvements -__. _C1. w..
Omer and (2) t.C`.�_.�C.- ((-.Ke .l.:
Total and(line 1 plus line 2) (3) - _
i y $ ',,Residenfalimp improvements or (4) a
annually manufactured home Garage (Si � -'I
x▪1 .s, -a
`"_C;.39%
1
Other improvements (6) sV._:.,�_: s 2'a a4
Total improvements(line 4 throagli line 6) (7)
Total value(fume 3 plus line 7) (6)
I hereby certify the above is true,correct,
Signature oiAssessa eat dgcea(msrap day,leer)
and complete.
Vaayng Win-Swaim of audear Data shirred(met day.Ivan
iu'+ ` # 1 } t',-,. f-r ". � TAUS AR OW CTION ALL.Vi4NC -"-`-' --
20pay20 Lesser of 60%of the assessed value of the homestead or$45,000.
Nointlistancang 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
red exceed (1/7jof the assessed value of mobile home or manufactured home.
Sga,se of o Oar
'r�
DISTRIBUTION:Original-Cony AiPa,FiaSTanped Copy-Taysyer
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