Mobile Home_Evans CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t �,: STANDARD/SUPPLEMENTAL DEDUCTION FORM
�-'+,�'' SSW Form 10
n sus HC
�1�f''] Presented by et c epap+eK a Lcad Gwen:rot Rimers
INSTRUCTIONS:See reverse side tor tang 6rsfmcdors.
NOTE Teleplwm,Sodal Security drivers Fermat,stare identification and federal We:at: on numbers are cw&durffal under IC 61.1-12-37.
- CERTIFICATION STATEMENT ' �1�
I(We) - certify that(..A ... In
711I+!j �)
place of residence a am(are)buying the fo0vaiag desuibed real property under contract krwhich a 11�t�F - -
Deducion is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Ovm. 0 Am(are)buying under recorded contract JAN 2 5 2019
o Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the tout or the right to oca y the property under the lens o1 a quaked personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. , • A a7
_ a,. a�W1T11tr.
CLAIMANT'S R:FOwnATIO11 ;I, - - -
Nazleedarar(1egd,n �m --R
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Scan Storey amber of comrades spasm pan ern duds) Drivers boas I kfenticahontater number on damats spouse Lest awe dyed luting Riga
(atrFahb orI)'aa/pcmnfs span does not have a swim wary mrberj
- -
V oris,a on armad.Fee Sande carers rare
Reach's office mite aroact is rewthd Read=ger Page
Corti ToeraNP ]' (ray m.rn, �)�b)
_Pas rsmber Legal desap^cn Is to property in pun
ID/ ,(L fidr//r ❑Realpcpnr v¢m mobile
ey assessed moei (IC 6f.1-7)
If any porter of tee readapted momre Or to lard rat ad eedng (1)we t�i",CYa+vredate Red to tuness aum w a e thred paten
al the properly united m matesbo ne /\ )t At D-(f
"2-6. - L AT — OS Is' /-00
--. - PROPERTY,OWNED ELSEWHERE BY-CLAIMANT ...
Sty.Canty,and Township Is da avant vacating a homestead?
❑ Yes ❑ No
of dainaa
hereby certify the stove statements am true,correct,art complete,
Address d cmrad(lea ereat Mee;dh:side,and ZLPcpde) Addressd vacated her+restead,Ferrr Wrmer ern sues(ay.mot end ZIP cede)
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LI .A 1 ■ r .. t -I Po ��
ASSESSOR USE.ONLY - 'i ASSESS D VALUE_,• -i 7HOHESTEAD/ALUE .iI" - NON-RESIIDENTIAL,s-"„
Land not exceeding one(1)acre Immediately .. -16 T; r
rrm sunoung residential improvements (1) ., +- ; "'r'r" _ .
tilr {Other and .
Total land(line 1 plus line 2) (3)
Residential unlnovameah ar or °wp (4) ter ?-w ems_.Eit;w
annually assessed mobile l -:�,�
' s -
manufactured home Garage (5) x..,_v .„r•..--...
Other MIMI/anent. (6) .zC.•:=.wY-.,:--rSt:._ -_._
Total improvements(lire 4 through line 6) (7)
Total value Gate 3 phs line 7) (e)
I hereby certify the above a true,correct, 59wrre ofAsaza ChM dared(raZh,MY.yea)
and complete.
Vertytg sSai-Sigs:se afktt' Dale dgled(manic dry,Yew)
-... - - STANDARD OEDULTION ALLOT'/Alr'CE� _ -20 pay 20 Lesser of 60%of the assessed value of the homestead or$45.000. •
M1bhettStance g any otherprovisiw4 the sum ate deductions provided in IC 61.1-12 to a mobile home $ •
that is not assessed es real property or to a manufactured home that is not assessed es real property may
not exceed one-ha/(1/2)of the assessed value of the mobile horse or mamdachved home.
Ssnaltre
4 l.,- !/ / �//n/A`y - Cate signed(north,dey,ywn
cflodbx
11-12-4-1
d -nott Original-CasMax.liSlanped Copy-Taxpayer - / '
5i1»a alCorn Az
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