Homestead_Fidler (5) 4 a. CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
—C.7 STANDARD I SUPPLEMENTAL DEDUCTION FORM
Stab Ferri 5173(R1T/1-15) HOW 2`
Preacihal by the Oepabat of long Government Finance
INSTRUCTIONS:See reverse side foragog instructions.
NOTE Telephone,Social Senalr drives'cense.slate ktertaaralm and federallderallicabon numbers are confdenffal under IC 61.1-12-37.
I(We) i i li certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following desatbed real property under contract for which a Homestead Property Tax Standard
udion is hereby claimed on the date this application is signed, (data of signature). 1(We):
Own. 0 Am(are)buying under recorded contract
❑ (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
O Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence bust
❑ Arn(are)the shareholder, partner,or member of the entity that owns the property.
Norte rant paged �
.
Social Seamy
- \\
Mice C Th�1ei1 .
Social Seamy;amber at chimeras spouse(tha five 6pla) Drives Somas/ideefhrdbn r Other
Recedes cede where contract is recorded Read rant Pep
- . - PROPERTY DESCRIPTION - _ , _
Cam To Tory Stria ON•larM1 osrefd.'6
A." 5-0
•
Pars) 4 • Legal derapzn loony e pastac
earPr ,�ry ❑Armaay assessed rotas ho me(1C 5-1.1-nI art partm atu
she rpat m
al aare or to lad nor s et asedng ore(1)sae h inmectadysvtan is used in Polo Insane,dmaae Me use and portion
d me rape*IfTOM b Palm brow
D,L- a-18 - 3ro4 -toy 3 g,�--o- ' .
•- = IM_ - PROPERTY OWNED ELSEWHERE BY.CLAANT -._ _
Sate -
Sn Catty,aidTam ;®a . . Is claimant vacating a homestead?
0 Yes 0 No '
Signat
ot claimant
I hereby certify the above statements are tree,correct.and complete. 1 j0
Abbess d cars!(rater end street city.Sr.and ZJPmrb) Address d vacated tvaniesead.d my parntereddreef,ay,are,and ZPmt)
'ASSESSOR USE ONLY -.+ •
_ ASSESSED VALUE _;_I HOMESTEAD VALUE....) NON-RESIDENTIAL 1 .,t
VALUE
Land not exceeding one Immediately es h-- _ r=
m sonoundmg residential hmpvemenb (1) �1 r'_% ^- a`
Other land (2) -_ •I -- �•
Total land(line l bus Me 2) (3)
Residential improvements or DweNng (4) DECb O �}l`'U �.. `+ - '_
annuallyassessed mobile 1 LL t Tg
y i - z
manufactured home Garage (S) _.,::.C,.-,rx..�,._-i..___x-°_'.'
Other Improvements (6) , t .-r _ �2� .
Total Improvements(litre 4 through Me 6) (7) ',1J�n� -"GIBSON t.uurr i .�h �TR
Tatty value v i 7) (6(line 3 ph Ina )
I hereby certify the above is true,correct S fB otAssessar Date signed(rnPxq sax feel
and complete.
Veifyaq action-Signature a/Adt Das eerier(tint&day,)ea)
-- v •-' :; - _� '� '- '- ''�-STANDARD DEOUCTIOIJ ALLOI'JAWCE '� � - • -"
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. .
NoMi hsfanca g any tallier provision,the sum of the deArc'uons provided in fC 61.1-12 b a mobile home $that is not assessed as real property or fo a manufaWreW home that is not assessed as teal propertymay
rot exceed one-half(ff2)of the assessed value of the mobile lone or manufactured home.
Oats sowed(montheray Yew)
1wv�S�1,� -ttel �i 1 Z -12
DIS1WerfilON:Origao-Covey AUSa,Re-Stamped Copy-Taxpayer
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