HomeMy WebLinkAboutHomestead_Powell (3) c;,-K. CLAIM FOR HOMESTEAD
PERTY TAX YEAR
% " STANDARD/SUPPLEMENTAL DEDUCTION ED CTION FORM �(/�
�.` -, Sian Fan 5473(R1711-16) HLYU 2y pR
`S��y Pr gibed by Se Department a and Goverment France
— �+�
INSTRUCTIONS:See reverse side forbbng ms6udaora.
NOTE Wep5afe,Social Search;drivers ioense•state idertflcaUcw and redo alklentitica6ar numbers are confdn5al uderIC 6-1.1-12-37. ,;,✓i
IPe) 1- Q‘3 on Qt,..s ci I -
y that I(we).<., . pa. .
place of residence a am(am)buying the laboring described real property under contract for which a .. . • -- - ax Standard
Deduction is hereby dairned on the date this application is signed. (date of.�,. afore). Ilk\�i VIVJ
�O . 0 Am(are)buying underrecorded contract
drac. NIPI�v
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Rave a beneficial interest in the trust a the right to occupy the property under the terms ofrdi a qualified personal -•
•1 r -tiro w UO\10R
❑ Am(are) the shareholder, partner, or member of the entity that owls the property. 1• , `jl P
- .. - -CLAli.1ANTS INFORMATION . - _
Nara of tJamaa(tagS pale) Tde(ivemrther 1 .
on • RocT. (
Sada
Naas al rats sparse(bgename)
Social Soarer number cicitmanrs Rene(b4 be dear) Drivers tense l ldeotJSdim IOar msthe d datrvKs Rafe(Iasi ea its) Isany Slant
WpIable only iapracats wane does na fete a scam seamy rxw )
CONTRACT RECORDED .. . . . . f
adobe an contract Fee Simple cones nano
Reaad&s cam ratio corned crecorded Reed manner Page
s s
Carib Tranship •s Taxi(deot(sty,tees mrmtlp)
C ( bops 3Q'bof
Para)narAr meal aaalpion isase prepay in destiac
LIJAres flan/ 0 Amery assessed mode laaa(,C 6-1.1-7)
It any corbel of me residential mare a to lam not cozening one(1)ace mat"¢rmedesy surname that Mean is used m pmdre income,de albs tie m al pardon
time crown uffired to produce inane.
a.Q,—tOal — ooQc1J _S3 o -COI •
- - - - PROPERTY OWNED ELSEWHERE BY-CLAIMANT.-C - - . _ -
Sxe.Carry.and Tasminp Is claimant vacating a lain e:atead7
0 Yes ❑ No
Saimaa of claimant
I hereby certify the above s(ements are tee,correct anti complete. V
Aches Smeacl(numbs and axe and Wale) Address or reed ham.law(ante are them,ay.sib.and Z/Pcode)
ct 1 t1 S SO E. t-LL `i_,.. • - n' 3 - - 41 i..l
ASSESSOR USE ONLY _ ♦.) .ASSESSED.VALUE. 1.'I OMESTEA \ALUE M1OriRESIDENTIAL C;
H D . 'VALUE
Lend not exceeding one(I)acre Immediately - f +i`s`is- r "` �y
surrounding residential improvements (t) "' �� T"j 3J -
v
Other land (2) 4,c 'CO - r
Total land(line I plus One 2) (3)
Residential Improvements or DsseOrp (4) - -
armmPcturedassessed nwb0el s 9MAtt 0-4 ?019
manufactured home Garage (5) - ...".:t-c_ _..-te US-5 -_."
Other improvements (6) _,�.-�{:W:.^-�__,.._:.: -_.i_- 1 d-
TotalimprovetnerrdplrreimrooghTme6) In GIBBON CCU i AUDITOR
Total value (line 3 plus One 71 (8)
I hereby cattily the above is true,correct,
dP<u<vr Date signed(trash,dry,bay
and complete.
Verifying tan Sianmea dkuddtr Dam sA+ed(mats dy.year)
- STAN DARDDEDUCTIONALLOWANCE -r_ - -- • __ - l
20_pay 20 Lesser of 6096 of the assessed value of the lama cod or$45,000.
NatalJrtaning any other provision,the sum of the duns provided in IC 6-1.1-12 to a moSe home $
that is not assessed as real property or to a manufactured home that is not assessed as teal properly may
rot exceed onMal(1/2)of the assessed value of the mobile home or manufactured home.
S r Die signed(north.dfi;flan
tasiR19UfON:Original County Auditor,Foe- need Copy-TaRaya
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