Homestead_Wirth (7) V--19 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
'v1 0 STANDARD/SUPPLEMENTAL DEDUCTION FORM a
Sao Fan 5473(R17(1,16)
HG70
RA
Resented by to Casement ar turd Goverment Finance
INSTRUCTIONS:See reverse side doling instructions.
NOTE rekphge,Social Secant(diner's tense,state ilemacarion and federal kfertificagen raa,Ners we cotderd)al under IC 6-1.1-12-37.
I(We)_ l31-/°/ . certify that I(we)occupied as my(our)P f
place of residence or am(are)buying the foraying descnbed real property under contract for which a Homestead Property Tax Standadl,fl
Deduction is hereby dallied al the date this application is signed, (date of sign). I(We- 12
L Own ❑ Am(are)buying under recorded contract. `S.... lOjB
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. CO
❑ Have a beneficial interest in the trust or the right to oa ipy the property under the terms of a qualified e�
dual personal residence
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. yea
'
Canty Tawmlap Turin trey,town.township)
n`` u_
Panel=Mat legal d is the arty ur --
gapaty ❑Arrpuey assessed mote home(IC 61.1-1)
liars pains a to nweereal nitre or as lard on aneeemg me(f)ace cat imeoabH sumx2rsd tirmre is used to produce icon,aeons M eve mil ponce
cide properly crazed b prat=i.mro.
2 & .... 12 -ig - /UL/ - Oo I. 665 -oz s
w.%-:--:'-; 'r6 r. t BROPERT,YOWNEDELSELVH-z-Rm.CLAIMA:JT . -. --7 -, v'
Sate,Casty,and Imelda, Is claimant vacating a hanesteaa'1
❑ Yes ❑ No
S4mm of claimant
I hereby certify the above statements are true,correct,and complete. /.//CJJ/'7 /J 1 y
Adders of mast(Hato&WO-•"" -flee end ZIP cod) Ad]rese9 edhaha e�I
deny Ws L t - . and Wade)
�'
A-
-r=''',. ASSESSOR USE ONLY 5'm : I •ASSESSEO VALUE j„( HOMESTEAD VALUE,. I r•NON-RESIDENTIAL ;`r•�
-VALUE '_ -
Land not exceeding one(1)acre lmmedatey r`' a>,
sermon:6 residential bmprovemenb (t)
Other land (2) :cc3a.o
Total and(line 1 plus line 2) (3)
Residential or I Dwane (4) ;As _ 3, 3-i tat
'-i a
manufactured borne Garage (5) x i 2'.'Mr x `i”)
Other improvements (6) r;rX_t.z- __=-r_f a •
Total Improvements(line 4 through line 6) (7)
Total value(line 3 pia line 7) (e)
I hereby certify the above a true,correct, S dASSassa Dam dOed(lrarq rby,yam)
and complete.
Verifying mean-Siouan of AudSr Data signed(mach dry,yea)
-
-
20_pay 20 Lesser of 60%of the assessed vedre of the homestead or$45600. �. . . .r.
NoMMMSaidmg any other provision,the stns of the deduGtts unsolder!In IC 6-1.1-12 to noble hole $
that is not assessed as teal property or to a manufactured home that is not assessed as tealmoperly may
not exceed onehal(Ii?)of the assessed value of the mob*home or rtumeacaaed home.
Sgara of Autos Date dense(Hari,dry,Peen
SA P.224_ 1,C(A lie -Ice? -/el
DISTRIBUTION:QIW I-Canty Author,File- roped COPY-Tageya
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