Mobile Home_Wagner ` ,_ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4 t STANDARD/SUPPLEMENTAL DEDUCTION FORM
Slate Faro San(R171 t-l$) HC10 2011
Neseted try ae Dgasnes a Leal Gevemaet finance
INSTRUCTIONS:See reverse side for Ong rssbuctions
NOTE Telephone,Soda�� SCeaafl drivefssfc(e�nse,state iderlfr5,'abon and federal itlerJ�affon numbers are oonfder,ai under IC 6-1.1-12-37.
I(We) a )� KJ(fl \ a certify that I(we)occupied as my(our)principal
place of residence or am(are)puy' following described real property lunch contract for which a Homestead Property Tax Standard
Deduction is hereby darned on the date this appfiation is signed, (dale of signature). I(We):
>Dart 0 Am(are)buying under recorded contract
(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal residence bust
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
• • CLAIMANT'S INFORMATION - -
lime adeaat(lgNname)
.
heard Seamy masher el dements acme(pa The Mph) Dines leave I c Other ame xXSn t Oba dementia spouse
(lest S.7.1 teeth Sate
(r raoetle aNuIderaprtfl apane do esrnthaw o a t saaNaeasaymaeber
e•a
If b o*e on wawa.Fee Simple corners name
Parades atm where attn is recorded Road ratter Page
�. �-PROPERTY DESCRIPTION `_•:: '
Casey < Towst , Taxing assist(stye ben,o emslvy) _ .• -_Patel O`n c . � e mom .
Real powa+r ❑"J�fL�j�',��.•,a-. ( a- n
t any paten el the resMartal structure a We land nal exciting erne CO acre that immmedsefy audios is used to Rear®roam,desate the tee aid portal --
o IS aspatY rebel to poem insane.
JAN 2 3 2019
it-4),s -'Cs\ go-oo
•
.-....: :.'_ - 3:PROPERTY OWNED ELSEWHERE BY LAIMANTJ _,� :_ - .P. d.
Sam,Casey,a Rieman d Riemanhq Is clamant -: .J: + v `•_.
Gt SQ a A ' ._, DITOR
dame`
I hereby certify the above statements are true,coned•and complete.rt
Address Scatted( arch Meet ow,,gee.and HP all I `(number a m a�, my are street,al robe St ZIP cock)
St o W Wcw,a .s1N lot 5-11--
_"
" 'ASSESSOR USE ONLY ' :;) %%ASSESSED VALUE _I HOMESTEAD VALUE' -I J NOu REV SIDENTIAL )
- -�: 1n
Land not exceeding one 0)acre Immediately - --> I —J r l
_suroundmg residential bnprovements (1) . .nt Xv-J. ,.,:+-,
Other land (2) rs{t sz
Total land(line I plus line 2) (3)
ResidentIal improvements or Dwelling (4) s
annually assessed mobile I fi
manufachned home Gangs (5) -E
Other improvements (6) . ,7,�; .�_ „�.,,
Total improvements(line 4 through line a) in
(a)Total value(line 3phs fine 7) - -. -
I hereby certify the above is true,correct, SJgaro aP<ee-tea sae crowd(morn cox Jon)
and complete.
wsifyig anam-SPame a/mita Date egad(north,Coy.year)
_ _ - - ,- - STAfJDARD DEDUC➢OtJ gLLOI'JAIJCE r ,-, ;, _ o-: _ -- t• _ .;
20 pay 20 Lesser of 6096 of the assessed vase of the homestead or$45,000.
Notwlhstarldrg any other Wovislat,the sun of the deductions provided in IC 6-1.1-12 to a mobile home $
that is riot assessed as real properly orto a manufactured home that is not assessed as real property may
not exceed onehal(1 2)of the assessed value of the mobile home or manutachred home.
tday.lea°
ralue `Stew I t� c signed
•- 19
DISnWBIITi0ft:anima-Canty MAW,File-Stamped Copy-Taayaya
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