Mobile Home_Hurt -- - - 4'..,.• CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
E- ,,,� STANDARD!SUPPLEMENTAL DEDUCTION FORM
State Farm 5479(RITI 1-1$) NOM 20l 1 .
Stibajory Prescribed by the Department et lag Gcvaanal femme
INSTRUCTIONS:See neveme side for tag insbuctiortt.
NOTE Telephone,Social Security.ends Ecense,state Mentz:kat.,end federal Wen:Meafim numbers are wftdertal under IC 6-1.1-12-37.
' I(fit 5 tN.I.O e s W • certify that I(we)occupied as my(our)Pnncpal
Place of residence or am(are)buying the following desalbed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby defined on the date this appfratton is signed, (date of signature). I(We):
0Own ❑ Am(are)buying erhder recorded ramact
❑ (are) entitled to owupy as atenant-stockholder of a cooperative icusing corporatipx-
❑ Have a beneficial interest in the Must o the right to oeglpy 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.
N • �
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S►Sckwr r
bbds
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1_ 1a
RemdaS office where mwffi¢recorded MAR 1 4 20 : ... '"ar"°" - Pepe
' _ PROPERTY DESCRIPTION�..y .. -. .- _
Carey Towel* Tavpdoted(^y.. _ il
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Parcel La a i � CID Ste CO N AUDITOR
❑Red pmFeny 0 A.vmly assessednoblelm•(IC 6-1.1-�
t toy parecn d the reasW eructate a se land not etceemg one(1)sae ern pmedaYly stnandf oat mudn is rued b ante tube daecVe en vie and paten
d de popery Wired to pmdce bum.
a6_ - 4x4 C�n3p7- -0O .
- . ' ' PROPERTYOWNED ELSEWHERE BY CLAIMANT T -. ... " -
State.Cony,are Township is claimant vacating a homestead?
daises*
�� 0 Yes 0 No pT-T �,!`�J{/1 '
I hereby certify the above statements are true,correct and complete. 6L 1 3 S or 1 r Y ^' '-
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Address d canffi Ovate-err/sheet(*As e,and ZIPmds) Addressor vacated harnesbad.sap and Meet,Morten.end ZlPcode)
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'ASSESSOR USE ONLY _ ; I. DNA LUE-,- - HOMESTE..D VALUE -- hOr-F SIIDENTIAL _
Land not exceeding one(Dame Immediately , ., of -trt
surrounding residential bmprovements (1) _'2r.{, - >'S(I`-s. i .
Other land (2)
Total land(lie I plus line 2) (3)
a-, -sue -_ It
Residential improvements or Osvegbg (4) ", f-h _- -o_ -v."::'_ a:
annually assessed mobile I
'.., .
manufactured borne caroller (5i '{_._ p�
Other improvements (6) ......3:p._;:-::.--,:-s:._..-_
Total Improvements(line 4 through line a) (7)
Total value(There 3 plus line 7) (S)
I hereby certify the above is true,correct, S of Assessor Cate egret(melt ox Yee)
and complete.
verifying exact-Straps*d Aulte DSo aipiad(rradA iteg Yrad
__ _ �. ' - _ - -- STAt:DARD DEDUCTOI4 ALLOWANCE - .- �. - t.
20_pay 20 Lesser of a0%of the assessed ague of the homestead or$45,000.
�g erg other provision,the sum mthe deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed es real property or to a manufactured hone that is not assessed as real property may
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not exceed one-hal(1R)ai Me assessed vats of de rtbbde home or annfactred home. 1 G eof �$s1 12�Y \WS1FIBU ION DI -Carty Autad,He-Sampan Copy-Taxare J •
Pagel of