Homestead_Elpers • ... CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
1. ••-.,:,o STANDARD/SUPPLEMENTAL DEDUCTION FORM
r�- '-a'y" Stet Ran 5473 Q217/t-167 HC10
�r� Prescribed try the Derma of Local Goverment Etna
. i 1
INSTRUCTIONS:See reverse side for King hsbtxbwp.
NOTE Tmeepfone•Social Seaid divers license,slatederffcason end federal ident pn numbers are•• -..-err iTtde!C 31.1- 217. 1
.� CERTIFICATION STATEMENT 1
I(We) .�d/I•IU�:E•3�,r,I i certify that(M'e) Q yn frinhipat
place of rev - 5-Cr am(are)buying the following -.real properly Under contract for which a Horti FSUNP•... "C SWgard
Deduction is hereby claimed on the date this appIcation is signed. (date of Signalum). I(We):
❑ Own ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-s[oddwlder of a cooperative housing corporation. a
occupy �(+
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms 013impapiri{a l+ Iris(`dA A
O Am(are)the shareholder, partner, or member of the entity that owns the property.
Name c-,-..-. ..al inns) ms,ibm dmnme
BadSaeuty t .Ad. A_ e 9 orljt„ , �. am6ea ea���ed ( i�. 305 0i I co
c mmwJ
;Bow r:s:_== AJ
Name ddements spouse gnat nags)
Somas Smsty r.mber of closets spouse We Owe Qgds)I Dthas Yee.,lded n I Other number of'lsi. *s spade(act five dg6y I Isavq Sts
Wpfrable or/yi epp5mmt's yams Mee not have a sedan smutty numberl
If butte on area.*Fee Shops pads name
Recorders°Clue store contract is recorded Record amber Pepe
PROPERTY DESCRIPTION - „(• -
• A/./ ToleaNp Taag dsbicl(.., -
,'�/P��ared tasav6er Legal&lsaists(''� Is to. ...7 n c,eseea
VN �e ,.•• lb. —elf 0 Re pm:" 0Armml,assessed mettle home(/C 6-1.1-7)
It any port==at ore radeidd store or is IaM na weeds.°as(I)ace tat enmecttey snouts tat saltsy is used to{roam Ion,desale as as and portico
of as property raced to pmdse Came
- -•.i:�s .t li•- _=�. . ;PROPERTYpWNED ELSEWHERE CA IMMIT .t -.r ..
S Carly and To natl Is claimant vacating a homestead? -
ae.
❑ Yes ❑ No
I hereby certify the above statement:5 are true,correct and complete. 4� aid
�' /wl en R--[rnEF'�]att—nom
--of contact(maoberml sheet dy,alas at ZW ) (.31 Addeo I -,•.•h.- .-d aary(r4mds atabeK abc Xas.etlzlPcS)
• • . •5 ad_ _thus t_
:,�I ASSESSOR USE ONLY "- _ ASSESSED VALUE -NON-RESIDEtTIAL.j .- S1
,m .. I ;1 HOMESTEAD VALUE
"" _ VALUE D
Land exceeding one r latey 9surroundmgresidn np.�m ea (I) t et a:1 ?v-
Other land R) x = .? ec
i:-
Total land(line 1 plus line 2) (3)
Residential improvements or Dwe0ng (4) x 1 i •
annually assessed mobile I
manufactured home Garage (5) r d : Ce."
Otter Improvements CO ._..._.,=_.:•.:a14:ZW�:`
Total Improvements(line 4 through line 6) (7)
Total value(line 3 pits fine 7) (8)
I hereby certify the above is true,correct SigoS.m of Assessor Daze Caned(matM1 cox lead
and complete.
Veifitg assn-SiW-lse ddAudYV Des sicced(na-aA any,lead
-
' +: ". -.-- _ TAN.AR. s D TINA SWAN r -j r•` 'b•f %.�
20_pay 20 Lesser of 60%of the assessed vie of the homestead or$45.000.
NahNAStand$g any other provision,the sum of the deductions provided in IC 5-1.1-12 to a mobile home S
tot's rot. es real propdfy or ton :.. .•... home that is not assessed as sealpmperty may
not exceed• (Uq of the assessed va .of the mobile manufactured home. tl�/�p '�lj Y'�1/J
If,
Sig�sa of413r NW Daze n / 1
otSTRO li1ON:Oripate-Canty AuK,FisSenred Copt•-T j 3 ,)2