Homestead_Lewis (12) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
r C STANDARD/SUPPLEMENTAL DEDUCTION F0RM
r�- Stab Faro St73(R17 I 1-16) HBO ZDIS
Prescribed by the Depart-tent It lame Goverment Rona
INSTRUCPONS:See reverse side for fling instructions.
NOTE Telephone,Social Securiht dnle/s license,state idenfacadon and federalideal:gha*mn numbers are cafidrnftal under IC 6-1.1-12-37.
• I • certify that 1(we)occupied
place of residence or am( ' the following descnbed Tat property under contract for witch a Homestead P
action is hereby dabbed on the date this application is signed, (date of re). y
Own. 0 Am(are)buying under recorded contract.(are)entitled to occupy as a tenant-stockholder of a 000petatiiv housing corporation. DEC 7 208
18
❑ Have a beneficial interest in the trust or the right to oc ipy 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. n
r;
tsgdnerm) •
",,• / �
Sams Sonny order of tlmoars spas(0st The goer) Drivers imay n.I nteicaeai IOthr amber a demen'a spree(RV Eve 7s) tsea9 gab �..
(A1plmde teppCxat3 spa®±ee not haveesarnlsystyI,OCt J
aburng an contra*Fee Smote osiers name
Recorders Dike%tree mimed is recorded Read amber Pegs
Canty A T strorroger Teats&solo(dy roan township)
iii been- u�e�1 d Pr)n flan
Pate ae:mr Leal desapast is een pmpstty n aesoan
0 Real popery ❑Annually assessed made hone(IC 6-1.14)
If am Patam al eve meidamrd strucese or be tad M extc one(1)acre tatimmeddely esrwtls Mon structure is used b papaws inmate desrate re use aid palm
a ee pnpeny titled b pretties beam
-i2- 07-302 400 /90- 028'
r --• •--. ' PROPERTY OWNED ELSEWHERE BY CLAIKIArd T- _ --:T'
Sae,Casty,aid Tanta* .. I.. - Jr .�: .atroneesteaa7
•;% Yea ❑ No
aNe otdabna6 /1
I hereby certify
the above statements are free, red,and complete. U at,.. -. I`�— l/.a//...:
Address at em'allamasant street ri4 ZiPced) Address at vacated
tat�dla,rem(amber ad shed,dry:scab.and➢Pass)
// Se - at if f'//nalva4 r 1A1 4-7G 70
ASSESSOR USE oiler ;.I -ASSESSED VALUE ` HOt.1ESTEAD\ALUE ,` trori RESIDERTIAL.
Land not exceeding one(t)acre Immediately (1) #-.- j etr i+,.
surroundmg residential improvements _:-'E,i. +;
or
Other land (2) zs- :6�.=' Lr�?..5:,
Total land(line I plus line 2) (3)
Residential inmrovements orDweOng (4) o^'�A *11 s,
annually assessed mobile/
manufactured boons Garage - * s on
improvements (6) i r I-.blYC �•
Other' drib <[ut„_:,T�{5 ,>,--_c--__ _
Total improvements(lure 4 through line 6) (7)
Total value(line 3 plus data 7) (6)
I hereby certify the above is true,correct,
of Assessor Date rose(clay day,year)
and complete.
OP—eying arson-Slgratn of/rubs Date egad(math day.Yeah
.. . -. •_ - - _ STAY.DARD DEDUCPOIJ ALLOI'JAtJCE __ ._ t - _ .- . . '
20_pay 20 Lesser of 60%of the assessed value of the homestead or$65,000. - .
Notwit stantsng any oterpmvism,the sum of the deductions provided in IC 61.1-12 to a imbue home $
that is not assessed as real properly or to a manufactured hone that is not assessed as mar property may
rot exceed one'has(112)dthe assessed vale dine mobile home ormanufacbaed home.
°Motor Dab Cgned(saort7)ea)
2.
7
DISTW BUTIDN:Original-Caery Aodda,Foo-aanped Copy-T
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