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Homestead_Craney p CLAIM FOR HOMESTEAD PROPERTY TAX YEAR STANDARD!SUPPLEMENTAL DEDUCTION FORM Sete Fmn 5471(R17i 1-16) HC10 21313 - - Presented by Co Department or total Goasmhet Fiance INSTRUCTIONS:See reverse side bar tang 1utuc6w2 NOTE Telephone.Social Searle%chimes foense,stag bpr155UtDrh and federal kkrterCarmn warders are confdr:real under IC 6-1.1-12-37. I(We) Ohn a•1 sta• un ontrac2 tertfy that I(we)occupied as my(our)principal place of residence or am(are)buying the following d real property for which a Homestead Property Tax Standard DeductionDe is hereby claimed on the date this application is signed, (date of signature). I(We): I[. Oxn ❑ Am(are)buying tender recorded mnbad. /�(are)entitled to occupy as a tenant-stocddder of a cooperat.co ve housing corporation. ❑ Have a beneficial interest in the trust or the right 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. • '. If Wjip m mdart,Fee&role pre 's name ! - - Randers age Merle mrdsd is recorded NOV 27 4 rdm`"°er Page -i' �. ., - PROPERTY DESCRIPTIOM��• .. _ _ - s Cary Tosnslip • rot it.ITY Tasip 6sbid(ap;yf - -a/ _Parcel mother tegedeamho iciefpbcvoaty in • AUDITOR 0 Rea pcpmy ❑A.nmvdy assessed cioSe home(IC 61.t-7) U er7 portion of the residential eructse or to tend not eaea4g one(1)acre that ewtatately ancuam tat structure is used to aoa®were,desate 1e use at portion d 1e property Lazed to practice borne. b -fit - b3 - Zoo -otL. 084-- © ol . �PROPERTYOWNED.ELSEWHERE BY CLAIMANT Sate,Cary,and Tomtit? Is dabnan( =-7.a hornestearn ❑ Yes o �/SjaL1 T I hereby certify the above statements are true,oonect,and complete. Address of coact(rxamveal meet,city ace,and Id core) a mated hmmd,art deed Ma .st tauate,and ZIP code) eljaak A 'gyp S' ! V - - - -'.:I - hOP-1ESTEAD VALUE • t.OIJ:RESIDENTIAL - -`ASSESSOR O DSE NLY r _ ASSE- - -- - - ^I VALUE Lend not exceeding one(1)ante Immediately (1) sunoundmg residential improvements Other Iona (2) Total land(lire 1 plus line 2) Residential Improvements or Dwelling (4) umm6y assessed mode I manufactured home Garage (5) Other hnprowemente (6) k.' _ .1:421:: q3. _ Total improvements(fie 4 through tine 6) (T) Total vane(line 3 pha rue 7) (e) I hereby certify the above is true,correct, SQ'a'ao of Assesses' Dam signed(moron city,poop and complete. Verifying action-Sidman of aorta Derr signed(moan day,lean - -STANDARD DEDUCTION ALLOWANCE .�; 20 pay 20 Lesser of 60%of the assessed vane of the homestead or$45,000. Nobsebstancf g any other provision.the sum or the deductions provided in IC 61.1-12 to a mobile home $ that is not assessed as reel properly or to a nemdadwed hone that is not assessed as real property may rot exceed one-ha/1(1/2)otthe assessed vabe of the mobile home or mam4achaed home.SgwedAadmrS h e J ) T)ae'dpamN e • DISTRIBUTION:Origial-CareyAuda,Fie-Stamped Coy-Tepeyer Page 1 of