Homestead_Wilcox n= $;, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t1 ;e.^` STANDARD/SUPPLEMENTAL DEDUCTION FORM
` ' State Form sacs Rt17/1-15) HCIO
— j nesammgthe 0aavaaaartnm Gal Frame
INSTRUCTIONS:See reverse side bt6lrg instructions P.I '
NOTE-Telephone,Social Seemly,driver's&ease,slate idenfocabon and federal)tlbtb a6on manners am contdrl&al under IC 6-1.1-12-37. Eb
CERTIFICATION STATEMENT - -
(We) '7.\OY'1 Q -( I Cry X certify that I(we)occupied as my(our).p :g
place of residence or am(are)buying the fon:ming described real property under contract for which a Homestead Properly T Standard ?No,
Deduction is hereby damn on the date this application is signed. (date of ceicaatvre ):
0 Own.
buying under recorded contract
❑ Am(are) entitled to occupy as❑a tenant-stockholder of a coopetel%housing corporation. "�CSO�Co 4,
❑ Am(are) shareholder, partner,or member0 Have a beneficial interest in the trust or the that to ocapy the�the property.under the terms of a qualified personal residence 11usf q�O/TOR
- - - _
Itbthsy m extra:,Fee Sivpb oars mane
Raawvs ogee Were ended is recorded Read natter Page
Cady Toestee Tmrg dreis Pay,town,berms*)
7' t bizSC(1 \`n.\ 0(1 .
Pa¢I'aniba ups descpah Is as property In question
0 Red property 0 A.nimay assessed monde rome(IC 6-r.1-7)
It any extol at as medOaCe aurora or to and all euethg grid(1)acre to mmeoa2Ny anards that Mrdre is used b proaxs income,devotee to tse aid postal
d de snooty teamed b erotica income
aul-\� .\ \-goo -yea . u3a.-oaf
- _ :PROPERTY OWNED ELSEWHERE BY CLAIt1ANi, _ _ v
Casey,Cos aid Township Is dalmant vacating iaanestead7< .
❑ Yes
Salrert
+e or claimantI hereby certify the above statements are true,correct,and complete.
Address dccoart(number and&Teat dly,sob.and ZIPcod:)) Address d read ivnedeeS,d any . -all seed city she,end ZlPwde)
—) 01-1 5- U •0 . S 1 ' - A . — . �®
'=+'ASSESSOR USE ONLY 3-' -ASSESSED VALUET �-'I'7j_HOMESTE O VALDE.±-.I�r NOtJ-RESIDENTIAL ^;�_.
_... -. . . . i _. .. .. VALUE- -� ...
Land not exceeding one(1)acre Inmediately > '-
Surroundngresidential bnprowements (1) : -f$' St -+. Cs• _._
Other land (2)
x
Tonal land(line 1 plus line 2) (3)
Residential improvements Or Deefing (4)
annually assessed mobile I e
manufactured home Garage (S) ems _V.r.:---,g,.--- -`
Other Improvements (6) r....�s+, t..� z.r. ._M
Total Improvements(line 4 through line 6) (7)
Total value (rime 3 pas lume7) (0)
I hereby certify the above is true,correct. Signature dAtaee.r Dab stilled(Horn,day year)
and complete.
Valley acorn-Sig:are dfodar Dalr signed(nary day,lea)
v'-" - - STAP:DARD DEDUCTIO1J gLl0\VAIJCEI" '-_ �. ''� - rt
20_pay 20 Lesser at 60%of the assessed value of the homestead or$45,000. . .
NotwitstandI g any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real properly orb a manufactured home that is not assessed as real pmpeM may
not ensued one-hay(1/2)otthe assessed v of the angle home or manufactured home.
Sign' e a dior 4k-AJ Dab signed(co dy yea)
Ili—A e .
DISTRIBUTION:Original-Can'yAa@a,ReSarped Copy-Taepeya
Page 1 d 2