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Mobile Home_Ingle (2) --.- CLAIM FOR HOMESTEAD PERTY T f • �y�Sy STANDARD/SUPPLEMENTAL DDE UC�nON FORM YEAR • ``-� , 53b Fare OR IS) HOW111 0,'J Presented by lee Department altar'Government Forma INSTRUCTIONS:See reverse side forSLog bubucfont NOTE'Telephone,Sodal Seauf(K drivers ,state iden53ra5m and fatal Atna6on numbers am confidential under IC 61.1-12-37, a CERTIFICATION STATEl.1ENT a I(We) (/�� VOX - certify that I(we)occupied as my(�)principal place of residence or am(are)buying the xi g desalbed real property under contract tot wtridi a Homestead Property Tax Standard Iced is hereby claimed on the date this application is signed. (dale of signature). 1(vJe): 0 Am(are)buying under recorded contract i Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ❑ Have a beneficial interest in the trust or the tight to oaopy 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. � ' Scab Smutty number or claimant's spouse(last be Cads) Drivels&xme I banfxatOn I Ober camber el dmnanrs spouse(Iasi five ) leading State (MO:ada any da➢Ocanta spouse does not have a soda!seaaynamoer) - kj-tr xe_y ."1: L-.Y ts.,....,'f7.'' -a:ri..CONTRACT RECORDED -.'z- s ...1 ' --k y- _ It toying al=tract Fee Simple owner's tame m Retela°boastta dn e conta reed-dad RdsUUr 2 4RR2 1 JJ�0 a Carty Townies s Taring tierinrl(aTy, temrip) S. Cr i 630r PV‘ ( 18bQm ^ n�rr.. elf T174 D Legal d ton Part amber Legal Is then question - _ _ .-. . ._ A 1LT Real lrcpcy 0 sassy assessed motile hose(X 6-1.1-7) It any porta d ale residential=care or the lad en exceecEng ore(I)no that inialechlOnY sarastt that abud<ae is used b Produce volt,Mures tee use add radian • d en popery tmiaed te poems burro. 2 a k28 —0Sn 1 g —0--0 / , 4 - -re PROPERTYOYIN ELF EELSE'NHEHEBY ELAIh AYTr.„ 2-_ - -.r Sze,Casty.at Tomtits Is claimant vacating a homestead? ❑ Yes No 1bS 9:7 I I hereby certify the above statements are bud,correct,and complete. ( I Address of cared(n ats-aid aaeet ray,axle.art 21Pmm) warted hsae»mt deny(smiler ands real sly,sate,ad Accede) A 3o2 ) 4sk 54- ?nn&q,,, NV ASSESSOR USE ONLY - AS -SESSED VALUE I r.,H . OMESTEAD VALUE ,{ NOt_RE L SIDENTIAL .' --r- - `-� VALUE :n-- Land not exceeding one(1)acre Immediately rs' Nt-Z g'„ surround-mg residential improvements (1) - - . =xa .-;'� Other land (2) L.x r -.:e.:_ Total land(line' plus line 2) (3) Residential vements or Dwelling (4) .fir Imo. see--_- =i annually assessed mobile I --': manufactured home Garage (5) e. g, ---t-1rk c,s Y = Other Improvements (6) _ c;� ., ,: -.:_ ?li( Total improvements(fare 4 through fine e) (7) Total value pine 3 plus fine 7) (a) ^ I hereby certify the above la true,correct, GrassedPcsxsa Date dyad(hush,day,year) V/` and complete. Vatftig action-Sgnsaze dAudbr Dza sfyral(rank day,yea) !\v -: - ST4NDAROOEDUCTIONALLOIYA(JCE�, -. . _ ® 20 pay 20 Lesser of 60%of the assessed vhom estead of the or$45,000. NMNMstancE g any other provision,the slap of the deductions mouthed in IC 61.1-12 to a mobile home $ that is not assessed as real property orlo a manufactured hone Oath not assessed as real property may not exceed ore-half(!R)of the assessed vete of the noble home or manuactured borne. S\ash Via CJ) I i v. 12�• Lxsint6UTR)N:Curl-Carey Audis,fitr56TOed Copy--reepares Page 1 of 2