Homestead_Martin (20) t r, STANDARD/SUPPLEMENTAL DEDUCTION EDUCTI N R
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r\-='+,�'-'% Stan Fora 5473 fR17/1-167 HC10
'% / Prescribed by Na Department abreact Government Fivers
INSTRUCTIONS:See reverse side for firm rubucburs
NOTE Telephone.Soda!Sear, threes Scene.,slam 4feregroon and fetal Atntrcafion numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT -
- I(yvp) • '19 40.—e./ a /Add -a - . es,certify that I(we)oca.'e.'..
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place of residence a am(are)buying the following described real property under contract to which a Ho --,-.:P•.1-- •
Deduction is hereby claimed an the date this application is signed, (date of signature). I(We):
O Own. 0 Am(are)buying under recorded contract MAY 1 1 2018
0 Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
O Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified person- residence trust
O Am(are)the shareholder, partner, or member of the entity that owns the property. J a1
.1 AlilligtOt
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Canty Township T...
Pall reenter 'Legal descriptors a.3• 403/f I t / Its the innerly in g cur
toga) ( 1.--141 I etlR certr ❑Annually assessed nate home(IC 6-1.1-r)
If any portion at the residential sincere or the land not exceeding one(1)acre oaf anmodaely would&act structure Is used m produce hoed,desWm he use and poem
of to property mixed to Pods Ian
03(o- era - / 7 - /oo - coo . &1 & -o ac/
-°n.., 7 /./ v3rw !4aRROP.ERTY.OVINED ELSEWHERE BY{LAIAIANT 's- r„6s5 :-'- r '4ien
Sob.Casey,and Township Is claimant vacating a homestead?
n 110 Yes 0 No
claimant
I hereby certify the above statements are tare,connect and complete._3� G Y
esteem
of redact(number en sheet city slate.and ZVPaod) Address araabdilamstd,tarry(rarn6er end sheet,r3y,r,WZD'wdr)
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53 1 W )zoos m Tl ,: J 4�7ro!Z
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ASSESSOR USE ONLY I - ASSESSED VALUE°_.,,I HOMESTEAD VALUE -+ NON-RESIDENTIAL-".
Land not exceeding one VALUE .
surrounding residential Improvements Immediately (1) �.{- -. - tr .�T..,c.
Other and (2) Y_ Ls'r-�.':-`_'1:3?—tc:r
Total land(line 1 plus line 2) (3) -
RseSldeNlal hmpuesno ..t or OweM g (4) 1 f i 3i-"z,
annually assessed mode l
manufactured home Garage r ./.'-__ -. -Y__ -;:;".
Other improvements (6) ..,', ,,,,M; ,;>4x-t},1cyc"-:=