Mobile Home_Byrns (2) Fro' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
:4;e. STANDARD I SUPPLEMENTAL DEDUCTION FORM
State Font 5673(R171,-16) 14010
Prescribed Cy Be OB(wMapa ot focal Government lion
INSTRUCTIONS:See revene side for Lang instrixtor¢
NOTE Telephone,Social Secret%drivels license,Neale idenfflicalion and federal idert fo metes are confidential under IC 61.1-12-37.
CERTIFICATION STATEMENT
I Me) ► Q S .a. a. certify that I(we)occupied as I• . 'f I ,,
place of residence or am(are)drying th-folbwing described real property under contract for whit a Homestead P..; T. ..9-
Deduction is hereby claimed on the date this application is signed. (date of signature). I(We):
❑ Own ❑ Am(are)buying under recorded mot OCT 26 2018
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust el the mid to occupy the property under the teems of a qualified personal residence trust
❑ Am(are) the shareholder, partner,or member of the entity that owns the property. '. • t •4;
Recorders Dace Wee cancan is recorded Read nutter Page
��"'0 PROPERTY DESCRIPTION _
Casty bonnie (sty;bes5 -
al nabs u, ,
Pe Legal/ b Be property in aerainrr�
0 Real property XL)/A•reay messed amble home(C 6-1.1.7)
It aril Palm of the reZential ammmre erIre land era em'eeL.Gae(1)acre that remedial*aaaeds err sbutre is used to pBam 4mn .donate the ere aid Poston
of Be property area In cream lumen.
11 ii a(9- 1-1a1-056,0_8- oa
-. - PROPERTYOWNEDELSEWHEREBYCCAIMANT '_ ,
State,Casio old Township IS Claimant vacating a homestead?
❑ Yes ❑ No
dmrta[
I hereby certify the above statements are tare,correctand complete.
6t � nD
anad(�arm=maec�;- e VP cacti Address d.arao- mesm a hd,aap(rwrberanf z3e,sa/ZlPmde)
- 3 cu .A v
ASSESSOR USE ONLY ,L(--•.c ASSESSED VALUE -.HOMESTEAD VALUE bold-RESIDENTIAL - _-
... .... ':I
Land not exceeding one(1)acre Immediately --re- ..;y n: i— �rl=
surrounding residential baprovemmb (1) ry .z--a 1a
Other land (2) _.=_ . . ...-. >..�" i:.vdGal5:
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) a--F• ,n - i
annually assessed mobile I {
manufactured home Garage (5) .z a s , 1- ..
Other improvements (6) ,_ -.. F '`.t •
Total improvements(lino 4 though line 6) (7)
Total value(rare 3 psus line 7) (8)
I (mama Fla%Teen
herebycon pre Certify the above is pun.correct
Si of Annex Woe rgedl ����
and epmWete-
Veayn➢emcn-Signature dandier Data yeah
' ., -_? v. _���-' " `-. _ c. 'STANDARD OEDUC➢ON ALLO\v1iNCE-�._ _ ", ", ,-.. _ _-..:i -T
20_pay 20_ Lesser of60%of Me asessedvdue of the homestead or$45,000. I I i
NonMdhstandrg any oiler provision,the sum of the deductions provided In IC 6-1.1-12 to a mobile home S
that is not assessed as real popery or to a manufactured home that is not tanned as real popery may •
not exceed one-hat(I/2)of the assessed value of the mobile home ormanu manufactured home.
Samara of AmPot
�2n.<, .4i _r L� j Y AUDITOR
DISmlmMON:Original Casty M art,FleStanped�i d Capy-Tagays
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