Homestead_Baisden CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sue Fam 5e73(Fin/1-16) H(:10
Prasaaed i y Pe Department at Loral Government Fiala
INSTRUCTIONS:See reverse side tor&g instrur5a¢
NOTE Telephone,Soda/Secvrdx driver's fare,stale identr5cation and federal butacafzrl numbers are con'd iral wider IC 6-1.1-12-37. �r�
I(We) • •• certify that l(we)occupied as LasJtral 1
place of residence or am(are)buying the fofoving described real properly under contract for which a Homestead P ax "i I I
Deduction is hereby claimed on the date this application is signed, (date Of signatu . i
❑ Oven. 0 Am(are)buying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. JAN 1 8 2019
o 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.
Loves 0agel )) '
Social Seamy hinter of del:aorta Rase cast the dPas) Diners tense/IdenoSus on I Oar number ctdai manta sparse pas the dpas) Wring San
(Axial*ayyIfexerts spans does nor ha saal seas*rusn6ar)
CONTRACT RECORDED - - .. _ . ..
o henna on aatact Fee Sipe comers name
Romeo's oboe Weer° end is moot Rand moor Page
• _- 'PROPERTY DESCRIPTIOV �' - _ • ,
Cam Towrsby Taxing chid //(
•
Patel isobar Legal asopem is the papacy l'i queMorc
yQ 5&J Soo ✓) 0 Redpaerty ❑M-rasey assessed canes leer(1C 6-1.1-7)
It any Man of We residential mumse or me land ne emedng me(1)acre tattmadsetysalaads ink SWAM.d use]ro produce ecru.',desaae the us3 ere portion
d be prpaiy maze to produce inane.
�t6-//- b5- 30a - joy. 1 o? - 0 A 7
PROPERTY OWNEDELS@.VHERE BYCCAIMA N.T °-, -',.. _ ,- -
State.Casey,and birdie Is claimant vacating a homestead?
❑ Yes ❑ No
in or rtapl�,J>
I hereby certify the above statements are true,correct,and complete. / (, , a G
Address donned(natter end sheet city.star,and ZIP s (..,1_._•ya.acabd tic tare bomber are sheet,at size,end ZIP code)
aJ. S /J Soo CAD g' L/ Z (al 0.
ASSESSOR USE ONLY -'. --I ASSESSED VALUE '!_ H061ESTEAD IALUEON-RVEALIUENTIAL '
Land not exceeding one(1)acre Immediately 11) ... ▪ ! -z _a3
surrounding residential enprovemenb _
Other land - __- (2) - - 'a--
Total land(line I plus line 2) (3)
} ha
Residential improvernerds or Dwelling (4) ▪ -
annualy assessed mobile
manubdsrred home Garage
., F ci
Other improvements (6)
Total Improvements(line 4 through Ire 6) (7)
Total value(line 3 As line 7) (a)
I hereby certify the above is true,correct, Stream dAtseeta DYs serf(man rlal;lea)
and complete.
Vtiyi ng scion-Signature dNmdbr Due awed(onto der lea)
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or$45,000.
Nobdhsbdnce g any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile holm S that is not assessed as real propery oro a manufactured home Thetis not assessed as real property may
not exceed one-hall(I/2)of the assessed vale of the mobile hone or manufactured home.
$gldasa�///`� irr Oath Woad(aoYq tel:Yea).
Origb.-CastyMnda,Re-Sawed Copy-Tawayer
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