Homestead_Gooch (2) "s`s+.l„ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4j��.le; STANDARD I SUPPLEMENTAL DEDUCTION FOB ''�y�
.2.4 Stem Fern 54y3(Rl7/1-16) HCIO 2-0 \ .
�ifcf''] Resented try the DF+b+Q Mary Go enomx Fenno
INSTRUCTIONS:See reverse side lording in5hucbons
NOTE Telephone,Social Seaway,drivers'tense,slide iden5Sm9on and federal kkribicartren numbers are confidante/under IC 61.1-12-37.
I(We) n • certify that I(we)occupied as my(our)principal
place of residence or am( ' 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, (data of signature). I(We):
u
yy Pan ❑ Ari1(are)burg urderta rerded contract
g(am)entitled to gcwpy as a tenant-stud holder of a cooperative housing wryoration-
O Have a la-id interest in the trust a the right to opt ipy the property under the terms of a qualified personal residence trust
❑ Am(are)the sha eholder, partner,or member of the entity that owns the property.
Name at tC rnnaad�(Seggal sane))
/`
M
Soe>d SeaanY
llssssWWy
N •
If bursa onmmact,Fee Scope cant s name
Recorder's a6m smite .tact is read FILE peas
.- - • - - _ _ 'PROPERTY DESCRIPTION,,..:�•/L�-. -
Canty T ,_� Tmmdsuirf(-., Feu•..•+•, .
crbso'� I SP .
Legal descyem la
y at ()ri rinds Mca(IC
u enYPralell Me nsdaCal so-flea a dr lard not ecceectm one(1)acre eat Mardaab m produce irronse,emote Me use awl postal
d the property rased In Podmi as e.
26 — 11 — 1 -3oo —7o4 . 7ro 6 - 023-
•
_ ,, PROPERTY OWNED ELSEWHERE BY.CCAIMANT� -i 1•`. . . - 'l
&ate,Garay,aid Township Is datmalt vacating a homestead?
❑ Yes 0 No
damart
I hereby certify the above statements are true,mnect arri complete.X it p /) /f
Address d contact(/uoteraa sheet.W.slue.and 2/Pa�) Address of vacated homestead,d any 4i!'h6erand cte ,taly�a,�•cool ZIP )
1000 S Old s(i- 65- 'ter -11-1 iO .
• ASSESSOR USE ONLY _ 'ASSESSED VALUE I HHOMESTEAD VALUE-k� f NC fbRESIDENTIAL -"z/
Land not exceeding one(1)acre Immediately tea• a' W-i ..-•dr -
surrounding residential baprovements (1)
1-`_
Other land (2)
Total land(line 1 plus Tale 2) (3)
Residenslal Improvements or Dwelling (4)
annually assessed mobile 1 5 .
manufactured home Garage (5) �"')=rx
- YS
Other improvements (6)
Total Improvements(line 4 through line 6) C7)
Total value cline 3 phs line 7) (a)
I hereby certify the above is true,correct, SJgnaaee ciAssessa Dos sipad(nntk days Jam)
and complete.
Veriryeg scam-Sipw are dndmr Date sped(monk day.lean
; `STANDARD DEDUCTION ALLOWANCE ' - - _- .
20_pay 20 Lesser of 60%of the ascxW vane of the homestead or$45,000.
NoMlLrstaMvg any other provision,the sum of the deductions provided In IC 6-1.1-12 to a mobile home $that Is not assessed as real poperty or to a manufactured horns that is not assessed as real property may
Mt exceed one-had(1r2 of the assessed value of the mobile home or manufactured home.
swan
, SM C '4 IDY�dord(nodJasy»a
06rR 1:Original Casty Ault,FeeSlanped Copy-Taxpayer
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