Mobile Home_Jones (2) Cr. CLAIM FOR HOMESTEAD PROPERTY TAX Foy YEAR .,1
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INSTRUCTIONS See reverse side bar gam Fc6udms -
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NOTE Telephone-Social Somata Calvert tense,slate ddeng5ra5on and federal identbcaffon numbers am confidential under IC 6-1.1-12-37.
• I(We) certify that I(we)occupied as my(our) • tP S
place of residence or am( )buying th ' described real properly under contract for which a Homestead Property Tax Standard e/
Deduction is hereby claimed can the date this application is signed, (date of slgnaj4 I 1017
❑”Oath. ❑ Am(are)buying under recorded contract. 99SO/y
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. Co
❑ Have a benefidal interest in the tout a the right to occupy the property under the temps of a qualified personal residence bust 1 k
❑ Am(am)the shareholder, partner, or member of the entity that owns the property. AVpy
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Na,,.et a layer,male) T✓aeproe miner of chimes
5 CJ( � slit) Sr?Q39 (
Named dernats spouse(kce!,sne)
Said Seamy number a daanaat Womb(bat the dot)I diver's Wean I law/kW=I Other ware of claimant's space Warne 6g d) (issuing Sae
(A(a eerie thyaaoptmnrs ware does at Jaw a sorer save/nnbr!
T-`s y-s :"' T ::CONTRACTiRECORDED :E:.:..- _T"'.ta :
If aging n corona Fee S6nae owners mane
Reorders ash whew ootrad S recorded Record rumba Page
01 - act_ 0:16 0U
PROPERTY DESCRIPTION -
Casty Torsi* Taxing dseid(ail:law township)
Pam renter LagBl is the Popery in question
\T (y/'n/�//_s-4,'/1 ❑Real p-cprb Plraany massed mobb rase(IC 6-1.1-7)
II wry potion a the resdrrial abaase of ale land not excxLg or(I) may aarw�eat structure is used b produce income.tote to use aid pawn
• of use property taloa b produce"vane.
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. PROPERTY OVJNEO ELSE:'HERE BY,CLAh9AY.T 4 - • '-1 -S•r1 i .-
Saes Canty,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
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I hereby certify the above statements are acre,correct and complete. ` �. // / L . �
Mtras a Caved(neuter WSheet oty acrd erode) jAAless`sCect vaca4d icy WS cc gate.re ZIP code)
- -ASSESSOR USE ONLY _ , ,,, I ASSESSED VALUE .1 - HOMESTEAD VALUE „I:; NO)-RESIDENTIAL;
' VALUE'
Lao not exceeding one(1)acre bnmedetely 3' sr' -
sonoondmg residential improvements (1) ei �. 'mss 1
i.
Other land (7) - . n,. ':-TPT._£.YZ_"«:
Total land(line 1 plus fine 2) (3)
Residential Improvements or Dwelling (4)
annually assessed mobile I
y
c manufaChned home Garage (5) . ',-r;„<.r :-. , ..Y_. r
Omer Improvements (6) arc j',E c y'\
Total Improvements(fine 4 through fine 6) (7)
Total value(line 3 phis fine 7) (e)
I hereby certify the above is true,co 1,
Signature aAsseu oat synch(nxmt4 day,year)
and complete. (�
Velfyng anion-Sipanaa Wafts \ \9 Daa dgred( -
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7-(y 77777-77-777- --STANDARD DEDUCTITIMTOIVATICE4yr:^+-`''�_'r"”' """71-7_ .-.:41..s.., /
• z0/D pay 20 / ' Lease a 60%a fha assessor nape of the homestead or us.Iwo. � Sep
Noheehstar,dl g any other prowls' the sum oft the deductions pvoNded in IC 6-1.1-12 to a mobile home S -
Mai Js not assessed es real properlyaloa manufactured home that is not assessed as mar property may re Q1)
not exceed one-beg(1/2)oi the assessed value of the mobile home or namdactred home. '31e9s
aSTWStTnON-Original-Carey At dta,FbSlanced Copy-Taman A00/7.0
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