Homestead_Whitehead (2) „,c CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r „. STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sate Form 6173 M1771-16) HC(o
Presented by me Departmera a Leal CSVaanaa Finance
INSTRUCTIONS:See reverse stile hlrfiling irsbucfionc
NOTE Telephone,Soda!Seaalht divers tcense,state ilesrff5cabon and taderal ktentlicaffon minters am confidential wider IC 6-1.1-12-37. r.. ]�
property under contact for which a Homestead Property Tax
D is hereby claimed on the date tits application is signed, (date of 90rlafure). ): 20/8
D Am( ❑ Am(are)lnryirld r of a rec«ded ve hous —�rtHlsO��
❑ Am(are)entitled to oaupy as a tenant-swckholder of a caoperatve housing corporation. Cpl
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residen&1( .
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. a(,
Ord,
Toetatrp T ' /�%(Myy��mr/Y,m rfl) �/ J
f �I / 07e-a /V W i"
nine I is the amatit
l]/✓ICGO 7p�� Real r+ryMr ❑Amueay as»ased mopiaM1mmitC 61.+-])
u aeye restarod smmme ape (1) tlal' em nine.is used m pat=income,Macao ale use and ratan
a laaeampadmmmm Tf 777/ 79 co
aG -0'(as /o3- Ooo. 396 -602-0
-.-,.c -,r. _ � ,m..PROP,ERTY,OWNED ELSEY:TERE BYsCAIMANTOBE•.'A gut .: oil -.�--7
a.Cans,and Township Is claimant vacating a homestead?
0 Yes ❑ No
Sipatae a
I hereby certify the above statements we true,correct,and complete. ✓ .
Address a mad(aster V seed,ay,sate,and ZIP cede) Ad Parry at Pre(a 7y.Nab are ZIPmde)
3 0 7 •0 sZ R, t r D
' > >:,:ASSESSOR USE ONLY t• �ASSESSED VALUE-„T,; HOMESTEAD VALUE _I IJON:RESIIDENTIAL
Land not exceeding one(1)acre immediately
sum/um:Oing residential improvements mtely. (1) "` }"" :i _ .-„
LL TOther ale (2) 4S`T:L ie^.u._ ,
Total and(line I plus line 2) (3)
;;S i.,2 s
Residential nprovemes�or Dwelling (4) _t:2=::;:fr`%e.; '^_.`=;__ .
annually assessed mobile I
manufactured Rome Garage (5) �ik-Irt- Y:3,
Other improvement) (6) ;f.`•n1r"::J„•"., +___.__a,°.;
Total improvements(line 4 through line 6) (7)
Total value Pine 3 plus rues 7) (S)
I hereby certify the above is true,correct, 6ipntva aASsassa Data snared(^°era•d x year)
and complete.
Veiling anon-Sigma-re of Audtx Data Sgied(nmraq day,yogi
.Y —'°i- _ - " _. . STANDARDDEDUCT1ONALLOWANCE A ... T?
20 pay 20 Lesser of 60%of the assessed vine of the homestea l or$45,000.
Noteehffindirg erry other provision,the sum ate deductions provided in IC 61.1-12 to a mobile home $
that is not assessed es mai property orb a manufactured home that is not assessed as seal property may
not exceed are-hat(1rZ d the assessed value of Me mobile home or nmadacbael home.
&g acre oAudmr Date signed(sat,,day,)ear)
OLSTR®UrnON:Original-Camay Art,Fie-Sxnped Copy-Twpger
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