Homestead_Ambrose '-a--. CLAIM FOR HOMESTEAD TAX
PERTY
e ,e. STANDARD!SUPPLEMENTALODE U FORs1
C ION - R
see Fam S473(R17/1-16) HC10
Presorted by the Depabnasd Local Government Finance
INSTRUCTIONS:See reverse side for Slog nstnxban.
NOTE Telephone,Social Seacittx diver's&ease,stale tie d5osiou and federalAtntfca5on numbers we catk Winfial e,IC 61.1-12-37. ��N lyA,
I(We) c113 e • certify that I(we)occupied as ) •
Y
pace of • or am(are)buying the following described real property under contract for which a Homestead P rd
Ded is hereby claimed on the date this application is signed, (dale of*vitaOwn. ❑ Am(are)buying under recorded Contract a EP 2 9 2018
❑ Am(are)entitled to occupy as a tenant-stodcholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust a the light 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. i 1r •c.
NmrYt LLyepanane) CLAIMANTSIfiFOW6ATI0t! 11�1 ofj
-- I . -1v
Named rats sparse peel name)
lit)ony (d,bxuc .
I"_-_c ,s' 'jT. W.,4. _ ••,.;•?__"CONTRACTARECORDED,'._--criT >^,-(rl--iy,-_ L2 -
Utuyig on mt,act,Fee Simple states nano
�
Recorders office where mrttld is recorded Rend amber Pap
Carey — T s Tao &arid(OW,belt roaNip)
11e3or1 , Taos,a� �hso
Perm Iepl desapRn Is prrtpalynwemas
Real Rt 0 Araanry messed noble trim(IC 61.1-h
It arty paean dee residential arise or en Isla not=ceding one(1)eae that immetaby mica:els used to produce income.&sate to use and carton
of ex corny utilized I profuse inure.
26 -Z2-1s= 300 002 . Ec -0 ,NLi .
' • 'a�ait7nPROPERTy.OVdNEO ELSE'NHERE 9Y.CLAIh1ANT .._. - 1 "y.` '.
Ste,Carry,and Toady Is claimant vacating a homestead?
0 Yes ❑ No
M
tlaunaa
I hereby the above statements are true,owned,and compote. -%OL 2J '
J'[
Mutest d oxtail(nmb&ed sheet aLt dab an ZiPeccb) d !C/hartffiag 4L 0 eV(in errend nreel,cal:state,end Zarcodu
y 1.25189 .( Ow1 kW& id / WM
ASSESSOR USE ONLY yr ASSESSED VALUEr.;g1 HOMESTEAD VALUE ,NO
,•ESIIDENTIAL_
u munmg�inkentia Im1provement Immediately
(1) e ?"tJ4.,'4. tf E .
Other land (2) a,'. _.0 ;_t_..-.. w
Total land(line 1 plus line 2) (3)
annually assessl ed
I Owe0ing (4) 1� �y4' z.,_�
mobile I ,t, ':
61.1.4
manufactured borne Garage (0) r Pr 1, . 1::
Other Improvements (6) . f.C3r ..�'_a-._. t:'.`
Tonal Improvements(lore 4 through line 6) (7)
Tour value trine 3 phs line 7) (S)
I hereby certify the above is true,correct, Sig»ce of Assessor Date dgned(uraah,dax yeah
and complete.
Vaiyig action-SgaVe of Amity _ Dan signed(north dry,year)
• lSr'ivva���"'t uiAi lkii, STAt:DARD DEDUCTION ALLOWANCE
20_pay 20 Lesser d 60%of the assessed due of the homestead or$e5.000.
Nobsfhstandmg any Wee:provision,the sum of the deductions provided in IC 6-1.f-12 to a mattes home $ -
that is not assessed as seal property or to a manufactured ed hone that is not assessed as real property may
rot exceed one-had(1,2)of the assessed value of the mobile home or
Gionat
aedA Shen& Smile) cra_ 2i t 8
Disarm 10N:Odo,-CaatyAuax,,Fie-92ruWd Copy.Taxpayer
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