Homestead_Farington CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4,1 STANDARD/SUPPLEMENTAL DEDUCTION FORM
slag Fogy S4Tl(Rf 1l 1.16) HC 10
-- PRfced by Fe Cepart:lrnl of Local Government Fence
INSTRUCTIONS:See reverse side for CEng Mstructions.
NOTE:Telephone.Social Seamy.mhre(s icense,awe idenfnca'I,n and fud:+alilfia03®Lifn nwnD(us am confidential under IC 6-f.f-f 2-
. ' .. �t - - CERTIFICA➢ONSTATEME UT ;- '.:.: «+ ! :.ace:��
I(We) _L. 'C %t(/T- k/?/r✓L i/✓(--Th ii certiy that 1(we)occupied as my '..).. .�'
place of residence or Am(are)buying the following described real properly er n fact for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, `'-%J�a// / _ (date of signature). I(We):AFI P R 9 5 2019
E Cm. 0 Am(are)buying under recorded cantina.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence 1. /1 lJl 1
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. 6-I ICY
. .`' n CLAIMANTS INFORMATION'. .'.(v- : _ .. .r.>r..):,ql;-r.•• NTYAUDITOR
Name a claimant R
Name r
I
Social
Rare of Wlmev's scene(*PO ape)
IZD/MC Cr F/XA /17 7Z'V
Soml Seventy
aa aowlnoerywaneer)
aburn on contract,Fee Shale owners name
deco-reeds or where carted is retched Record lumber I Pape
-- an,Iowa*
(3COA( Tom eh lean cslo/tilS0/if
P I number L Le^aI dess:�gcn t//i Wire:
II it. n Rester.'
O 73/6•" 1li'V tAte'/f/`/"1e ��-YJ/0%rl Ct�/ I Bar Rea lRPeb ❑Amalfi assessed meat Mere(C blf-I)
o any pith et the resrfensa saurure or the lam not eiettcNg tee(I)we Mal nra fl/sanoewa Mal structure•s Yalu to proAFe femme Celeste be on arid person
of we property uIffiee u produce am e_
2 .-23—/4— - 092 a 675- 02t/
Sale,Canty.and Toansbe Is dalnant vacating a homestead?
0 Yes 0 No
Scrato cline 7
I hereby certify the above statements are true,coned,and complete. ` {r.4_4_l f, ,n/7A If L'1
Settee of coded(nnnae.egor street rtysft.,a:a ZP oat '7 Address of ranted maaaed,a ear( as sbe(y/rey,doe.one ZIP coda)
/ 63 aS' c*Etta i V t-Y 414/g.Sfl fDV
a t y:ASSESSOR USE O' tc I. `�ASSESSED VALUE. I HOMESTEAD VALUE NONRESIDENTIAL'
Land not exceeding one(1)acre immediately (1)
surrounding residential Improvements
Other land (2) v _
Total land(One 1 plus line 2) (3)
Residential improvements a Dwelling (4) • -}"1 ' .
annually assessed mobile I
manufactured home Garage (5) -
Other improvements (5)
Tool improvements(fine 4 through line 6) (7)
Total value(line 3 plus line 1) (8)
I here by certify the above is true,conec.
Weer,4frouasof dusKwed Port,-ear.feed
and complete.
VMM1X ecfs.-Signaure cikla'r me sense b orals dab reel
20_pay 20_ Lesser of 60%of the assessed vbue of the homestead or 545,000.
NalsEhstandug any other provision the sum of the deductions provided in IC 6-1.1-12 to a motile home $
that is not assessed as real property or to a manufactured hone that is not assessed as real property may
not exceed one-half(sr)d th said value of the motile home or manufactured Acne.
ayraeae eitAt j �r.C,//, � 77,..,
19
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