Homestead_Shoulders CLAIM FOR HOMESTEAD PROPERTY TAX 0 YEAR
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STANDARD!SUPPLEMENTAL DEDUCTIONb FORM 'S
s' so Fam s4rs(R t7/1-16) HC10 2
PrsmDamarataa by the Oara or Local Gam eoert Finazzo �
INSTRUCTIONS:See reverse side for Hung nstrucsons.
NOTE Telephone,Sacral Seaat &Reds foense,stale ld_ntdm5on and federal ident aeon numbers we tartden5al under IC6-f.1-12-37.
swim;�- ';^CERTIFICATION STATEl1ENT _
I(We) 4 A4) c21U1y that I(we)ocoupled as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, • (dare of signature). I(We):
Vol. 0 Am(are)buying under recorded contract
Am(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 trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
•
Nane cianat(legal W Q/ pm') • •_
Sodal Scanty rambati clamant(lust the age)' awe ioaee I ldaNfi¢9on l Other number at daiwa(lestte� I I55a .
t '
Saud Seaaty amber d date'spur(bargee e Etcse ma_T+ I renter d damst's sparse(bS(He -,- ' bogs;Sate
JJllffll tie aP s . does not haw a scam sec atynwNet)
5J??1 _:1:, i 7 e name:;,i ;_ 11- i-CONtRACTRECORDED '... - _:1 •.;:s::..._,... ..........: �'.1:z. `._.
awyng am costal Fee Simple viers �1^ s I I. -.
RemVas ogee Mae coma is recorded Read amber Pape
• ,
--7 x". ....6:,.$Ga--.c .'' Sxrm t� L-KIS:6 ?bgs:d9'IOY:i:.4- : .{tom, z' . -,tea cI _a"
. ...... .. ..n
lYSImH. .T .. Tadry ds6id(rly)rioael township) - . .
�'V> ;ir,nte.ktvn
Pam legal elm :`an Is in question - ..
eS ccpeity _ ❑airy fly assessed note.tome(IC 61.1.7)
par?portico tithe resuaGm sbtasae a the lad not oneecErg cue(1)acre eat irnmedwaegsc actre is teal to Pea bon,crate the use and carbon
at the property'sited b produce name.
6� \Z.= p1- ==k01RT= 003.211_ _._
- o Zs .
-. .__ ,� Ar!:t•+::PROPERiY,OWNED ELSEWHERE BY,CLAIMANT _ :5 `+'F2_ v , .Psi-.
Sate,Casey,aid Township Is claimant vacating a homestead?
❑ Yes D No • -
•
t sgma+v of rip.nad
�
I hereby certify the above statementsct e ' .
are true,corre and complete. y - �dan�
''
fLtii
Address at amad(nmmmbr�^^��s6x4 ciy,meet adZIP m1H Address a maned Jwrcstead,Gary(number as at;sale,cue ZIP code)
sfoil "f �'7ia1Cr.:.� ' f C.ptrN.ti .loom;° e
Land not exle dingone(I)acre Immediately - f. -F" +T -}T.y
surrounding residential improvements (1) a.� '� ti:'-} ,'
Other and Y'•F.:`'Y'cTiaT"-.,��T".=":yid,
(2) C•• ';r'�cz=. z—dt3`-=cur.
Total and(lime I plus line 2) (3) ,
Residential improvements or Dwelling (4) • es.3—w., 7sJ r-:.
annually assessed mobile lfa "
manufactured home - m T 'Garage (5) a !.
r
Other improvements (6) r4,.'d- gag- tea ,t
Total impovements(Iute•1 through line 6) CO - _ .
Total value (line 3 phis line 7) (6)
I hereby certify the above is true,correct, •''se of Assessor Dee siaal(n t' day;yea)
and complete.
Vadrrog ton-SOatse ciAdhar Date signed torah,dry,war) '
..- ..._ _ .. . ...0 .., . me m oSTANDARDDEOOCTIONALLOIfAwcE„_t r _ <_ r. _._.,. __.`,1
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. - •
Notwithstanding any other provision,the sum of the dedltttns provided In IC 6-1.1-12 to a mobile home $
that is not assessed as real properly or th a manufactured home that is not assessed as real property may
not exceed one-hat(f/n Nitre assessed vain of the mob*home or manufactured home.
Spatae of kxi r < Data signed(tady da(yea)
DISTRIBUI1ON:Oeigial-Casty Audta,Faeaamped Copy-Tepeyer
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