Homestead_Foster (3) +• 5:. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
'��:e. STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sate Pam S473 pill i 1-16) HCIO 2004 .
Rewted A me Deaaonaa a lad Government ream
INSTRUCTIONS:See reverse side forting i sbuMons
NOTE Telephone,Social Seaally,drivers k ense,state iderd5caion and federal ide, afon numbers ere ow—Marta]under IC 6f.1-12-37.
I(Ale) — y that I(we)occupied as my(our)principal
place of residence am(are)buying the following desmbed real property under contract for which a Homestead Property Tax Standard
'Paton is hereby claimed on the date this application is signed. (date of signature). 1(Nre):
Own. 0 Am(are)buying under recorded Contract
❑ (are) entitled to ocarpy as a tenant-stockholder of a cooperative housing corporation_
X
❑ Have a beneficial interest in the trust cc the right to soapy 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.
name adazoaapager VQS-rent .. $'\
Social my ranter d clamant pan eve 60*) others Same l ldat ion l Other rumba a carolI +(last apt Isrvg Stele1 .
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Soda seamy a terra ecru s spa8a(de five 6� Cirat lama l ld rtSdah I Otter nanber N datats mouse(last liw day Lsebg...
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Recorders aace Were contract is recorded Record number Pape
t ! : 2019
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Carry Toeatp
• -4dN1h
Pad reinterLela dexwiporn '' ' - haat -
GIBSONCOUN ❑
Reaatpely ❑A,r.ey assessed mobae home(c i.i-n
It arty paam a ee=Saaa sure or the land na ecaeam me(1)awe eel hnmetsy amends that swmae is used to matte Frnre,desate ere use and pardon
a the aaatytabed to coon income. 4 / (�
`�.6� IS r,`\ --LiV!� 0 002 .gVS — 0Lk .
. .PROPERTY OWNED ELSEWHERE SYCCAILMAttT•'-.. -
.. -- - - '
Sam,Casts en
d Township Is claimant ---•r •a homestead?
❑ Yes ,►o
I hereby certify the above statements are true.corteG.and complete.
Addmsa (nrmbaad sheet cite,slab.and ZIP ale) -! +cardI. ...h ad.aary • .•. andabaU,mad:sae,andZlPatde)
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V . :-- ASSESSOR USE ONLY ) •ASSESS ID VALUEY:. _' HO1 4E67E4 O VALUE...1 hOq RESIDENTIAL -.
1
Lend notexceeding one(1)acre Immediately �� >(s -fs-- -T`surround-mg residential improvements (1) m—.... .i "t —,..„4. +`,
Other land (2) ° c3s ct --;«
- Total land(lie 1 plus line 2) (3)
Residential meets or h Y improveDwelling (4) z<r3`t'4.':..i,-cr3lit l:l1Sait
annually assessed mobile I -.
frI
m b anucbtred borne Garage (5) �' `; .._=__
Other improvements (6) 4,.. r.-.,S .v -s,t a
Total improvements(Me 4 through rune b) (7)
Total value Gone 3 piss Me 7) (8)
I hereby certify the above is true,correct, Scrotum of Assessor Date signed(rmrxq day,)md
and complete.
vetting anon-Signature aA„Sa One aided(mre14 day,yard
20 pay 20 Lesser of 60%of the assessed vane of the homestead or$45.000. .
Nottiistandbg any otarproclaim,the son of the deductions pm%lded in(C 61.1-12 to a mews home $ .
that is not assessed as real property or to a manulaa wed bone that is not assessed as real laopeM may
not exceed one-ha 1/2)of the assessed value of the mobile home or (,-{\\��/� `p''j/Sonnies a . "`a e 3(2 8-1 1
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DISTRISt ON:Origin-CmrayAzIIOx.RaSlatwed Copy-Tavpeia •
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