Homestead_Woehler ,r- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t �;.e. STANDARD/SUPPLEMENTAL DEDUCTION FORM
rt Styx Faro 54T3(R17/1-15) HC70 :I 1 ,1
i'Na t Presented by the Depatr &load Government RanceRanceRance • y . fit
INSTRUCTIONS:See reverse side for firing insmxdons i
NOTE Telephone.Social Seanily,driver's Dcense.state i erd5caaon and federal Idenbeabm numbers am confidential rider IC 6-tf-12-37.
CERTIFICATION STATEMENT _ .' ZU18
I MIS) M dot-�A [To \_s r�Jc e N-N\e 1r certify that I(we)occupied as my(our)principal
place of residence aim(are)buying the foTh wing described real property under contract for which a Homestead Property Tax
Deduction is hereby claimed on the date this applications signed, (dale of stgnafure). I 1), fuer Y-Ss
0 Am(are)buying under recorded contract GIBSON COW TV AUDITOR
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
- '
ajoV-.q .
Paralrsmiler laps de5a�.vf Is the property in gesdort
a/m p opety ❑A assay assesmd mole hue(IC 6/.1-i1
Yens cabal of he residential suave or the tend not eon shy an(I)acre that inmectably svmurit tent atnn um Is re a d to otincome,ee income,deasO h use
e e aidpardon
rtg d an pany toted brmdreFarm �co y OO
aU- L- - 1g - 1 . pig _(D -.1.
State,Casty,an Touehp Is claimant vacating estead?
❑ Yes
Sgnatre of claimant
I hereby certify the above statements are true,correct and compete.
atasse of catscipwrobrard stmt.rah side,end IL°ta ) Address or sated herne>nad,Wary(neater and teed.ids snits and ZPcde)
•
:.ASSESSOR USED ILY m - I - ASSESSED"WE _TI HOMESTEAD VALUE „NOn1;R ALIUENTIAL '___
Land not exceeding one(I)acre beinedia _
surrounding residential bnprovemenb (t) x 7,-;, r s
Other land k-:+. F ;1 -,.. -r
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwetlhtg (4) 'irikil :4 s ,,r _
annually assessed mobile I
menufactured borne Garage (5) c ( s7 __ --
Other improvements CO `t s�1Kr y_': a_^.v,:.��_
Total improvements(line 4 through line 6) (7) - -
Total value (line 3 plus line 7) (e)
I hereby certify the above is true,correct, Siptataa olAssessor Date signed(meat day,Yea)
and complete.
VoitYng action-Signare ofluStor Data steed(nzaq day.Yea)
'r4^ •sc•�-++ir'eai+'`-��.�-Y11N�1.1daLf�alalMsfai Q/_�fFi 3�_ i J-.�l�ea----i-.im,.�m-.
20 pay 20 Lesser ofeom of the assessed value of the hdntestead or$45.000.
Notetstaraeng any omerpovislan,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as seal property orb a manufactured home that Is not assessed as real properly may
not exceed one-hal(I/2)of the assessed value of the mobile home or manufactured home.
Strome of As for �^ cP Date dialed(monk MY,llead5 , l„.,:J(L, O- /D
U61f®IInON:Odd-Catty AudIDir,Ft, Copy-Tag:4W
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