Mobile Home_Donoho IM FOR HOMESTEAD PROPERTY TAX
4 < STANDARD!SUPPLEMENTALEDUCTION FORM YEAR
Stab Fan 5473(R17/1-1e) HC10
Prorated by the Departmental Local Covaner a F.mm
INSTRUCTIONS:See mlerse side totaling nstruclomt
NOTE Telephone,Social Seaaftl(threes lane,state IderlSrafan and federal iderdi5cafion numbers am mnfderkial under IC 61.1-12-37.
® I(we) oil— certify that I(we) our
pate of a am(am)buying the following seat property under contract for which a Homestead Property Tax
Deduction is hereby claimed at the date this application is signed. (date of srgn4 % I,(we):2018
❑ Own. 0 Am(are)buying under recorded contract. 3
O Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest In the trust a the right to oaupy the property under the terms of a qualified pers reside
❑ Am(are) the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORI.IATION '( . �aviwpll.d .T;4'P1'o:)C rstu..I TOR
"
Pleaded,ohm Were mama Is recorded Road ester Page
PROPERTY DESCRIPTION- " • "
Case Township Tang tanct(a/y,term tegansep)
Patel ranter Legal
9 , /� 9 2 8 to property n Qnterr ,`i
I / V / J Is O Restaoperlr y]�r¢¢➢y assessed mole Moe QC 6I.,-7)
if any pa to d to Urania!enamor Ma lad m eamdag ow(1)am mat renedley erase th am stumae is tact bpromce\\\ •��Se��pan
® at he properly utt¢e0 to p'ohm En
a6- `fall - 0001 '73 - oo IAYk
--?-7 _ - '`r6-..a. SPROPERTY OWNEDELSENHERE BY C7AIMANT,- P:'- ,'"�-rq- 3f`�" , _
-c
stm.Carty.and Taanstap Is claimant vacating a homestead?
` 0 Yews`0 No / ,,
I hereby certify the above statements are true,correct and amPlate.]( / 2,s 5. 0 (d 1. £cl Gs-- .
d caold nrmnLvml arms.and IIPmtb) / \Address banes/or i am ^�-dal Meet,city,sate,end LP code)
r - i, r� A.) A.) Zk 7670
'ASSESSOR I. E ONLY - ) ASSESSED VALUE. . I HOMESTEAD VALUE r'.I NOn RESIDVALUENTIAL
Lend not exceeding on*(1)era Immediately` - ,[s r" i.;�,•
surrounding residential improvements (1) T `1474, cow a 1.ly.w�l(
Other land (2) .x,_ :'s_" .._u.:---:v::'_
Taal land(line 1 plus line 2) (3)
1„_G;S::-Gl.Xu> -
Residential improvements or Dwelling (4) ',:r_3- : fOn.:%'4-.. :itti,:
annually assessed mobile I
"'.`. :- . .
manufactured home Garage (5) "=>'c:` , .1O i '4i tZit
Other Improvement (6) 7.2
:_..,Y t } L '.
Total improvements(fine 4 through line 6) (7)
Total value (fine 3 phs fine 7) ter)
I hereby certify the above is Ins,correct, agnateolAasessa Dab signed(motto,hex year)
and complete.
Vetting anon-Slgnatre eAu6Yt Dal signed(msrlq day,yea,).,oy
20_pay 20 Lesser of 60%of the assessed vaue d the homestead or$45,000.
® Nawidrslaufl g any Other provision,the sum of the c ctfliorl provided in IC 6-1.1-12 to a amble home $
that is not assessed as seal property orto a manufactured home that is not assessed as teal property may
rot exceed one-hall(Vq dfhe assessed vats&the noble home or manufactured home.
Sigmmredr 1- a / / `Oda cloned(awl)col:pores
te____...--•
.Ae- npaa Copy-Teceyer
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